Impaired Verticality Perception in Patients With Hemispheric Strokes: Prevalence, Associated Factors (Cross-Sectional Study)

Abstract

Introduction. In recent decades, among the causes of post-stroke postural balance disorders, a lot of attention has been paid to disorders of verticality perception. Impairments of verticality perception have different forms: from lateropulsion to pushing syndrome. Aim: to study the prevalence of verticality perception impairments during the 1st month after strokes and to determine the factors associated with this phenomenon. Material and methods. 205 patients with hemispheric strokes that occurred during the last month were examined. The Scale for Contraversive Pushing scale was used to assess the orientation of the body axis in relation to the force of gravity in the frontal plane. We determined socio-demographic factors, clinical and neurological characteristics, cognitive and psycho-emotional characteristics, neuroimaging parameters. Impaired verticality perception was diagnosed in 70 patients (34,2%): lateropulsion – in 61 (29,8%), pushing syndrome – in 9 patients (4,4%). No associations were found between impaired vertical perception and age, gender of patients, level of paresis, presence of apraxias and aphasias, NIHSS scale scores, modified Rankin scale scores, stroke type (ischemic/hemorrhagic), cognitive, anxiety and depressive disorders, fatigue, localization of cerebral infarction, level of leukoaraiosis, morphometric indicators of external and internal cerebral atrophy. On the other hand, patients with impaired verticality perception had significantly more often paresis (in case of lateropulsion - in 96.7%, in pushing syndrome - in 100%, in patients with normal verticality perception - in 75.6%), spatial hemineglect (70.5 %, 88.% and 17.8%, respectively), non-lacunar subtype of ischemic stroke (91.8%, 100% and 73.4%, respectively), lesions of the right hemisphere (73.8%, 77.7% and 57.0%, respectively), also they had significantly larger volumes of cerebral infarctions (20.3 (13.4-28.9) cm3, 24.1 (12.9-27.2) cm3 and 15.8 (8.5 -23.3) cm3, respectively). Conclusions. During the first month after stroke, impaired verticality perception is a common phenomenon associated with certain clinical and neuroimaging characteristics.

Impaired Verticality Perception and Postural Balance at 1 Month After Hemispheric Stroke

“…Порушення сприйняття вертикальності (ПСВ) є досить розповсюдженим явищем, зокрема за нашими даними, у відновному періоді гемісферальних інсультів у 29,8% пацієнтів діагностується латеропульсія, а у 4,4% -синдром відштовхування [7].…”