Novel Representation of Astasia Associated With Posterior Cingulate Infarction

Abstract

Background and Purpose-The representation elicited in the cingulate motor area has been demonstrated in animals, but remains unclear in humans. In particular, the representation and pathogenic mechanisms of the posterior cingulate cortex are poorly understood, especially in humans. We describe a case of posterior cingulate infarction associated with contralateral astasia. Case Description-A 67-year-old right-handed man with a 10-year history of hypertension suddenly presented with right-sided pulsion on attempting to stand or sit. On the following day, he could not maintain a sitting position. The patient immediately fell to the floor because of instability, characterized by marked right-sided pulsion despite no muscle weakness, sensorial deficits, or cerebellar ataxia. Magnetic resolution imaging of the brain showed abnormal intensity in the posterior parts of the cingulate, with no other clinically significant lesions. Conclusions-Because the cingulate motor area is connected to the vestibulocerebellar system through the thalamic nuclei, disruption of this connection by posterior cingulate infarction may result in astasia. (Stroke. 2006;37:e3-e5.)

Isolated astasia in acute infarction of the supplementary-motor area

“…Contralateral astasia associated with medial frontal lesions has rarely been described, and recently, only one case has been reported 4. Kataoka et al 4 described a patient with posterior cingulate infarction who showed contralateral pulsion similar to that of our patient.…”

“…They also described that thalamic astasia may mimic cerebellar disease. In other reports of astasia associated with other lesions, the direction of astasia was also contralateral to the site of lesions, such as the midbrain or posterior cingulate region 4 6…”

“…It can be caused by lesions of the thalamic ventrolateral region 3. Recently, there has been one report of astasia associated with a cingulate lesion 4. However, to the best of our knowledge, there have been no reports of astasia associated with a lesion in the supplementary motor area (SMA).…”

Differences in neural activation to depictions of physical exercise and sedentary activity: an fMRI study of overweight and lean Chinese women

“…Specifically, O-W women showed significantly weaker activation than leaner women did within the posterior ventral cingulate cortex (left BA 23) in the exerciselandscape contrast and marginally stronger middle frontal gyrus (BA 6) activation in the sedentary-landscape contrast, both of which are areas implicated in motor learning and movement. [51][52][53][54] Activation of the posterior ventral cingulate cortex is also related to autobiographical memory, kinesthetic memory of body movements, storage of motion velocity, visuospatial orientation and navigation of the body in environmental space. [55][56][57][58] Vann et al 59 reported areas 23 and 31 are more active during retrieval of real than imagined events, contending that re-experiencing real events modulates activity in this area.…”

Co-Occurrence of Astasia and Unilateral Asterixis Caused by Acute Mesencephalic Infarction

“…It resembles the marked balance impairment of patients with vestibulocerebellar disease [4] . The responsible anatomical region for astasia or astasia-abasia has been known to be related to the thalamic lesion affecting mainly the medial ventrolateral nucleus of the thalamus because the fastigial fibers of the vestibulocerebellar pathway project to the medial ventrolateral nucleus, and disruption of this pathway may cause thalamic astasia [6] . Inability to walk despite good motor strength was also reported in a patient with a red nucleus infarction involving the ascending fibers of the crossed dentatorubrothalamic tract, in a patient with a small medial capsular hemorrhage extending to the lateral portion of the ventrolateral nucleus of the thalamus and in a patient with a hemorrhage at the pontomesencephalic junction (midbrain tegmental lesion) involving the pedunculopontine area [7][8][9] .…”