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Pusher syndrome: its cortical correlate.

Bernhard Baier1, Jelena Janzen, Wibke Müller-Forell

  • 1Department of Neurology, University of Mainz, Langenbeckstr. 1, 55131, Mainz, Germany. baierb@uni-mainz.de

Journal of Neurology
|August 11, 2011
PubMed
Summary

Unilateral stroke can cause pusher syndrome (PS), a balance disorder. Lesions in specific brain areas, particularly the insula, are linked to PS, suggesting vestibular information is key for posture control.

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Area of Science:

  • Neuroscience
  • Neurology
  • Vestibular System Research

Background:

  • Unilateral stroke often results in pusher syndrome (PS), characterized by leaning towards the side opposite the brain lesion.
  • PS significantly impacts postural balance and patient rehabilitation.

Purpose of the Study:

  • To identify the specific cortical regions responsible for inducing pusher syndrome (PS) after unilateral stroke.
  • To investigate the association between subjective visual vertical (SVV) tilt, a marker of vestibular otolith dysfunction, and PS.

Main Methods:

  • Sixty-six acute unilateral stroke patients (28 left, 38 right lesions) were assessed for PS and SVV tilt.
  • Magnetic resonance imaging (MRI) and voxelwise lesion-behavior mapping were used to correlate lesion sites with PS severity.
  • Hemineglect was also evaluated as a related neurological symptom.

Main Results:

  • No significant voxel clusters were identified, but trends emerged.
  • Right-sided lesions showed a trend associating PS with damage to the posterior insula, operculum, and superior temporal gyrus.
  • Left-sided lesions suggested involvement of the anterior insula, operculum, internal capsule, and lateral thalamus in PS.

Conclusions:

  • Findings suggest a connection between brain regions controlling posture and processing vestibular otolith information.
  • Vestibular information appears crucial for maintaining body posture, especially in patients with right-sided stroke lesions leading to PS.