Is Lateropulsion Really Related with a Specific Lesion of the Brain?

Abstract

Lateropulsion (pusher syndrome) is an important barrier to standing and gait after stroke. Although several studies have attempted to elucidate the relationship between brain lesions and lateropulsion, the effects of specific brain lesions on the development of lateropulsion remain unclear. Thus, the present study investigated the effects of stroke lesion location and size on lateropulsion in right hemisphere stroke patients. The present retrospective cross-sectional observational study assessed 50 right hemisphere stroke patients. Lateropulsion was diagnosed and evaluated using the Scale for Contraversive Pushing (SCP). Voxel-based lesion symptom mapping (VLSM) analysis with 3T-MRI was used to identify the culprit lesion for SCP. We also performed VLSM controlling for lesion volume as a nuisance covariate, in a multivariate model that also controlled for other factors contributing to pusher behavior. VLSM, combined with statistical non-parametric mapping (SnPM), identified the specific region with SCP. Lesion size was associated with lateropulsion. The precentral gyrus, postcentral gyrus, inferior frontal gyrus, insula and subgyral parietal lobe of the right hemisphere seemed to be associated with the lateropulsion; however, after adjusting for lesion volume as a nuisance covariate, no lesion areas were associated with the SCP scores. The size of the right hemisphere lesion was the only factor most strongly associated with lateropulsion in patients with stroke. These results may be useful for planning rehabilitation strategies of restoring vertical posture and understanding the pathophysiology of lateropulsion in stroke patients.

Does Motor Tract Integrity at 1 Month Predict Gait and Balance Outcomes at 6 Months in Stroke Patients?

“…Balance function is a whole-brain phenomenon, rather than being associated with any specific part of the brain [27]. Previous studies, and our results, indicated that the CST, CRP, and CPCT are not associated with the recovery of gait and balance, just as no specific lesions affected the recovery of vertical posture [26]. The neuroradiological findings in the white matter alone did not predict the clinical outcomes in this study.…”

“…Reports suggest that injury to the insular cortex, postcentral gyrus, and posterior thalamus is associated with poor vertical posture [25]. A recent study showed that a larger stroke, rather than specific brain lesions, was more important with respect to the likelihood of restoration of vertical posture, where multiple sensory and motor systems are involved in the restoration of balance in stroke patients [26]. Balance function is a whole-brain phenomenon, rather than being associated with any specific part of the brain [27].…”

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

“…In total, three studies were of poor quality [26,30,31] and 16 of good quality [2,7,23,29,[32][33][34][35][36][37][38][39][40][41][42][43] according the Newcastle Ottawa Scale. For research question 1, all studies had a good methodological quality with a score of 7 or 8 out of 9.…”

“…Of the 19 included studies, 2 studies were retrospective [32,40] and 16 were prospective [2, 7, 23, 26, 29-31, 33, 35-39, 41-43] case-control studies. One study was a randomized controlled trial [34].…”

“…However, different cut-off scores for the SCP were used, 12 studies used the original cutoff scores (>1 for each section: symmetry, use of non-paretic extremities and resistance to passive correction) [2, 7, 26, 29-31, 35, 38, 39, 42, 43] and 5 used modified cut-off scores (>0 for each component) [34,36,37,40,41]. Table 3 provides an overview of the demographic data of the included participants.…”