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Kamada M, Yokota C, Murata S, Doda D, Nishimura K, Nishizono H. Dynamic changes of the direction and angle of radiographic ocular lateral deviation in patients with lateropulsion after stroke onset. J Neurol 2023:10.1007/s00415-023-11755-6. [PMID: 37160798 DOI: 10.1007/s00415-023-11755-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To examine if radiographic ocular lateral deviation (rOLD) could be provoked in stroke patients with mild-to-moderate lateropulsion according to vertical perception. METHODS In this single-center, retrospective study, acute stroke patients with mild-to-moderate lateropulsion assessed by the Scale for Contraversive Pushing were enrolled. Computed tomography or magnetic resonance imaging was performed on all patients on admission and then according to their conditions. The direction and angle of rOLD were compared among three groups according to the responsible lesion: lateral medullary (LM), pontine (P), and hemispheric (H). RESULTS Sixty-six patients (male, 47; average age, 67 years) were enrolled and divided into the LM (n = 37), P (n = 8), and H (n = 21) groups. All patients had body tilt. Patients in the LM group showed body tilt to the ipsilesional side during hospitalization, while those in the P and H groups tilted to the contralesional side. All patients had rOLD at the final assessment at an average of 13 days after onset; patients in the P and H groups showed contralateral rOLD, while those in the LM group showed ipsilateral rOLD if they did not have cerebellar or pontine lesions. Significant decreases in the angle and changes in direction of rOLD according to lesion site were observed during hospitalization. CONCLUSION Serial changes in rOLD findings after stroke onset are different according to the responsible lesion. The direction of rOLD in most patients is in accordance with vertical perception after the acute stage of stroke.
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Affiliation(s)
- Masatoshi Kamada
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Chiaki Yokota
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Shunsuke Murata
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Daishi Doda
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiologic Informatics, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hiroaki Nishizono
- Department of Stroke Rehabilitation, National Cerebral and Cardiovascular Center, 6-1, Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
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Ramaswamy S, Rosso M, Levine SR. Body Lateropulsion in Stroke: Case Report and Systematic Review of Stroke Topography and Outcome. J Stroke Cerebrovasc Dis 2021; 30:105680. [PMID: 33652344 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Body lateropulsion (BLP) is seen in neurological lesions involving the pathways responsible for body position and verticality. We report a case of isolated body lateropulsion (iBLP) as the presentation of lateral medullary infarction and conducted a systematic literature review. METHODS MEDLINE and EMBASE databases were searched up to December 3, 2020. INCLUSION CRITERIA age ≥ 18, presence of BLP, confirmed stroke on imaging. EXCLUSION CRITERIA age < 18, qualitative reviews, studies with inadequate patient data. Statistical analysis was performed using IBM® SPSS® Statistics 20. RESULTS A 64-year-old man presented with acute-onset iBLP. Brain MRI demonstrated acute infarction in the right caudolateral medulla. His symptoms progressed with ipsilateral Horner syndrome over the next 24 hours and contralateral hemisensory loss 10 days later. Repeat MRI showed an increase in infarct size. BLP resolved partially at discharge. Systematic review: 418 abstracts were screened; 59 studies were selected reporting 103 patients. Thirty-three patients had iBLP (32%). BLP was ipsilateral to stroke in 70 (68%) and contralateral in 32 (32%). The most common stroke locations were medulla (n = 63, 59%), pons (n = 16, 15%), and cerebellum (n = 16, 15%). Four strokes were cortical, 3 frontal and 1 temporoparietal (3%). The most common etiology was large-artery atherosclerosis (LAA) in 20 patients (32%), followed by small-vessel occlusion in 12 (19%). Seventeen (27%) had large-vessel occlusion (LVO), 12 involving the vertebral artery. Sixty (98%) had some degree of resolution of BLP; complete in 41 (70%). Median time-to-resolution was 14 days (IQR 10-21). There was no relationship between time-to-resolution and age, sex, side of BLP or side of stroke. CONCLUSION BLP was commonly seen with medullary infarction and was the isolated finding in one-third. LAA and LVO were the most common etiologies. Recovery of BLP was early and complete in most cases.
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Affiliation(s)
- Srinath Ramaswamy
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA.
| | - Michela Rosso
- Department of Neurology, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA.
| | - Steven R Levine
- Departments of Neurology and Emergency Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA; Jaffe Stroke Center, Maimonides Medical Center, Brooklyn, NY 11219, USA; Department of Neurology, King's County Hospital Center, Brooklyn, NY 11203, USA.
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Naoi T, Morita M, Kosami K, Mashiko T, Kameda T, Okada S, Hayashi Y, Kawakami T, Tanaka R, Fujimoto S. Clinical Characteristics and Clinical Course of Body Lateropulsion in 47 Patients with Brainstem Infarctions. J Stroke Cerebrovasc Dis 2020; 29:105183. [PMID: 32912551 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 07/17/2020] [Accepted: 07/19/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND In patients with lower lateral medullary infarction (LMI) located under the vestibular nucleus, proprioceptive impairment due to dorsal spinocerebellar tract (DSCT) is considered a pathological condition for body lateropulsion. In patients with brainstem infarction located at or above the level of the vestibular nucleus, other pathways, such as the crossed vestibulothalamic tract (CVTT), are considered responsible. RESEARCH QUESTION The clinical course of body lateropulsion between each anatomical level of infarction remains unclear. Further, whether body lateropulsion refers to a static or a dynamic symptom also remains unclear. METHODS We examined 47 patients who exhibited body lateropulsion and categorized them into four groups: lower LMI under the vestibular nucleus, LMI at the level of the vestibular nucleus, pontine infarction, and midbrain infarction. The patients' time to acquire static upright standing position and gait in a straight line were statistically analyzed by a log-rank test using the Kaplan-Meier method. RESULTS Body lateropulsion in the static upright position was less frequent in the lower LMI group than in the other groups. SIGNIFICANCE Lower LMI primarily affected body lateropulsion in gait. DSCT damage could affect ipsilateral hip joint or leg coordination, causing body lateropulsion in dynamic situation.
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Affiliation(s)
- Tameto Naoi
- Rehabilitation Center, Jichi Medical University Hospital, Tochigi, Japan.
| | - Mitsuya Morita
- Rehabilitation Center, Jichi Medical University Hospital, Tochigi, Japan; Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
| | - Koki Kosami
- Department of Public Health, Jichi Medical University, Tochigi, Japan.
| | - Takafumi Mashiko
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
| | - Tomoaki Kameda
- Division of Neurology, Department of Internal Medicine, Shin-Oyama City Hospital, Tochigi, Japan.
| | - Shunich Okada
- Division of Neurology, Department of Internal Medicine, Shin-Oyama City Hospital, Tochigi, Japan.
| | - Yuka Hayashi
- Division of Neurology, Department of Internal Medicine, Shin-Oyama City Hospital, Tochigi, Japan.
| | - Tadataka Kawakami
- Division of Neurology, Department of Internal Medicine, Shin-Oyama City Hospital, Tochigi, Japan.
| | - Ryota Tanaka
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan.
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Abstract
Tremor is a phenomenon observed in a broad spectrum of diseases with different pathophysiologies. While patients with tremor may not complain in the clinic of symptoms of imbalance, gait difficulties, or falls, laboratory research studies using quantitative analysis of gait and posture and neurophysiologic techniques have demonstrated impaired gait and balance across a variety of tremor etiologies. These findings have been supported by careful epidemiologic studies assessing symptoms of imbalance. Imaging and neurophysiologic studies have identified cerebellar networks as important mediators of tremor, and therefore a likely common site of dysfunction to explain the phenomenologic overlap between impaired postural and gait control with tremor. Further understanding of these mechanisms and networks is of crucial importance in the development of new treatments, particularly surgical or minimally invasive lesional therapies.
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Affiliation(s)
- Hugo Morales-Briceño
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Alessandro F Fois
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Victor S C Fung
- Movement Disorders Unit, Department of Neurology, Westmead Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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Abstract
Body lateropulsion is known to be caused commonly by lateral medullary lesions but rarely by pontine lesions. It is also known to be associated with lesions of the dorsal spinothalamic tract or ascending graviceptive pathways. We herein report the case of a 75-year-old woman presenting with contralateral lateropulsion and cerebellar tremor caused by pons infarction. To our knowledge, this is the first case report of pontine infarction causing both lateropulsion and cerebellar tremor. Our case may be helpful in anatomical studies of ascending graviceptive pathways.
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Affiliation(s)
- Ai Hosaka
- Department of Neurology, Hitachinaka Medical Education and Research Center, University of Tsukuba Hospital, Japan
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Lee SU, Kim HJ, Park JJ, Kim JS. Internuclear ophthalmoplegia plus ataxia indicates a dorsomedial tegmental lesion at the pontomesencephalic junction. J Neurol 2016; 263:973-980. [DOI: 10.1007/s00415-016-8088-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/02/2016] [Accepted: 03/03/2016] [Indexed: 12/11/2022]
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Choi JH, Seo JD, Choi YR, Kim MJ, Kim HJ, Kim JS, Choi KD. Inferior cerebellar peduncular lesion causes a distinct vestibular syndrome. Eur J Neurol 2015; 22:1062-7. [DOI: 10.1111/ene.12705] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/06/2015] [Indexed: 11/29/2022]
Affiliation(s)
- J.-H. Choi
- Department of Neurology; Pusan National University School of Medicine; Research Institute for Convergence of Biomedical Science and Technology; Pusan National University Yangsan Hospital; Yangsan Korea
| | - J.-D. Seo
- Department of Neurology; Bonhospital; Busan Korea
| | - Y. R. Choi
- Department of Neurology; Pusan National University Hospital; Pusan National University School of Medicine and Biomedical Research Institute; Busan Korea
| | - M.-J. Kim
- Department of Neurology; Pusan National University Hospital; Pusan National University School of Medicine and Biomedical Research Institute; Busan Korea
| | - H.-J. Kim
- Department of Biomedical Laboratory Science; Kyungdong University; Goseong Korea
| | - J. S. Kim
- Biomedical Research Institute and Department of Neurology; Seoul National University Bundang Hospital; Seongnam Korea
| | - K.-D. Choi
- Department of Neurology; Pusan National University Hospital; Pusan National University School of Medicine and Biomedical Research Institute; Busan Korea
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Isolated body lateropulsion in a patient with pontine infarction. J Stroke Cerebrovasc Dis 2012; 22:e247-9. [PMID: 23265782 DOI: 10.1016/j.jstrokecerebrovasdis.2012.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 11/05/2012] [Accepted: 11/07/2012] [Indexed: 11/21/2022] Open
Abstract
A 72-year-old man with diabetes mellitus and hypertension was admitted to our hospital with lightheadedness. The patient showed lateropulsion to the right side, but his neurological findings were otherwise normal. Brain magnetic resonance images showed a fresh ischemic infarct in the left dorsal part of the lower pons. Body lateropulsion is characterized by an irresistible falling to one side and has been reported in lesions in several brain regions. However, it has rarely been reported in pontine lesions. We suggest that physicians should be aware that pontine lesions can cause isolated body lateropulsion without other neurological deficits.
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[Astasia-abasia: psychogenic and non-psychogenic causes]. Rev Neurol (Paris) 2009; 166:221-8. [PMID: 19819508 DOI: 10.1016/j.neurol.2009.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Revised: 06/23/2009] [Accepted: 08/19/2009] [Indexed: 11/20/2022]
Abstract
Astasia-abasia is defined as the inability to stand and to walk, despite sparing of motor function underlying the required balance and gestures. Initially, astasia-abasia was considered a psychogenic gait disorder, but later on, the description of "high-order" gait disorders mimicking this pure functional deficit led authors to refer to "astasia-abasia" as a pure descriptive term, without a presupposed etiological or anatomical substrate. In this paper, the main clinical characteristics of both psychogenic and non-psychogenic astasia-abasia are presented and discussed.
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