Time Course and Predictors of Recovery From Lateropulsion After Hemispheric Stroke (Prospective Study)

Abstract

Introduction. In recent years, considerable attention has been paid to the abnormality of body verticality perception in stroke patients. Most often, misperception of body verticality is manifested in the form of lateropulsion and repulsion syndrome. Objective: to study the timing of recovery from lateropulsion (pusher syndrome) and to determine the predictors of lateropulsion resolution in patients with hemispheric strokes. Material and methods. We included in the study patients with hemispheric strokes occurring within the last month. 61 patients were diagnosed with lateropulsion and 9 patients with pusher syndrome, according to the Scale for Contraversive Pushing. After initial examination, patients were subsequently invited for a weekly examination until the body's verticality was normalized. Results. Recovery time from pusher syndrome was significantly longer – 9.0 (95% confidence interval: 7.1–10.4) weeks compared to recovery time from lateropulsion – 5.9 (95% confidence interval: 5.5–6.3) weeks. Among all the studied factors, only spatial hemineglect was a significant independent predictor of a much longer resolution time of lateropulsion (hazard ratio 2.36; 95% confidence interval: 1.20–4.27). The mean duration of lateropulsion in patients with spatial hemineglect was 6.3 (95% confidence interval: 5.8–6.8) weeks, whereas in patients without spatial hemineglect, it was 4.8 (95% confidence interval: 4.3–5.4) weeks. In a subgroup of patients without spatial hemineglect, higher Fazekas scale values were a significant independent predictor of longer resolution time of lateropulsion (hazard ratio 2.38; confidence interval 95%: 1.25–4.48). Conclusions. After hemispheric strokes recovery time from pusher syndrome is much longer than recovery from lateropulsion. Recovery time from lateropulsion is determined by spatial hemineglect and leukoaraiosis severity.