Lateropulsion with active pushing in stroke patients: its link with lesion location and the perception of verticality. A systematic review

Abstract

Background: Lateropulsion with active Pushing (LwP) is characterized by impairments in postural control. Previous research suggests an association between LwP, lesion location and verticality misperception. This first-ever systematic review evaluates the association between LwP, lesion location and the perception of verticality (PROSPERO: CRD42020159248). Methods: Pubmed, Web of Science, REHABDATA, Embase, Cochrane Library and PEDro were systematically searched on December 16th, 2021. Studies were included when examining lesion location or perception of verticality (Subjective Haptic, Visual or Postural Vertical) in supratentorial stroke patients showing LwP . Two reviewers independently screened and assessed risk of bias using the Newcastle Ottawa Scale. Data was qualitatively analysed and extracted.Results: Nineteen studies were included, examining a total of 340 LwP patients. Lesions in: the thalamus, internal capsule, inferior parietal lobule at the junction of the postcentral gyrus, the posterior insula and the superior temporal gyrus, were associated with LwP. Whereas all studies examining the Subjective Postural and Haptic Vertical (haptic only examined once) reported a significant increased deviation in LwP patients, inconsistent results were found for the Subjective Visual Vertical. Furthermore, the Subjective Visual and Postural Vertical showed inconsistent results for magnitude, direction and variability of this deviation.Discussion: A complex brain network, rather than only one brain region, seems responsible for body control with respect to gravity. A disruption within this network might lead to a bias in the construction of a correct internal reference frame, crucial for perceiving verticality. There was an association of LwP with verticality misperception in all three modalities. * ** * * * 8 Good Dai et al., 2021 [35] * * * ** * * * 8 Good Fraser et al., 2018 [30] * * * 3 Poor Fukata et al., 2020 [36] * * * ** * * * 8 Good Fukata et al., 2020 [37] * * * ** * * * 8 Good Karnath et al., 2000 [26] * * * * * * 6 Poor Paci et al., 2011 [41] * * * * ** * * * 9 Good Perennou et al., 2008 [2] * * * * ** * * * 9 Good Saj et al., 2005 [42] * * * * * * * * 8 Good Snowdon et al., 2005 [31] * * * * * 5 Poor

Pusher Syndrome: Not a Rare, But a Little-known Phenomenon in Stroke Survivors: A Review of the Literature with Report of a Typical Case

“…2 The prevalence of PS among stroke patients has been reported to be 9-63%. 3,4 It is more common in patients with right hemisphere stroke. 5,6 Deep subcortical lesions involving the insula and thalamus seem to be associated with the PS.…”

“…5,6 Deep subcortical lesions involving the insula and thalamus seem to be associated with the PS. 3,7,8 The exact mechanism of this peculiar behavior is unknown, but a disruption in multimodal sensory processing regarding postural control rather than a pri-mary somatosensory impairment is accused. 9 Studies have shown that PS patients have a deviated perception of subjective vertical regarding non-pushers.…”

“…Identifying the lesion characteristics of PS patients may provide insight into the neural networks responsible for the perception of verticality. 3 Studies in stroke patients suggest that the neural networks related to perception of verticality and vestibular information show hemispheric lateralisation. 25,29 Abe et al investigated the prevalence of PS in 1,660 cerebral hemispheric stroke patients and showed that it was 1.8 times higher in those with right hemisphere lesions.…”