Annals of Rehabilitation Medicine

Korean Academy of Rehabilitation Medicine (대한재활의학회)
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Characteristics and Prognosis of Pusher Syndrome in Stroke Patients

뇌졸중 환자에서 Pusher Syndrome의 특성과 예후

  • Lee, Jong-Hwa (Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine and Regional CardioCerebroVascular Center, Dong-A University Hospital) ;
  • Kim, Sang-Beom (Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine and Regional CardioCerebroVascular Center, Dong-A University Hospital) ;
  • Lee, Kyeong-Woo (Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine and Regional CardioCerebroVascular Center, Dong-A University Hospital) ;
  • Kim, Byung-Hee (Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine and Regional CardioCerebroVascular Center, Dong-A University Hospital) ;
  • Kim, Min-Ah (Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine and Regional CardioCerebroVascular Center, Dong-A University Hospital) ;
  • Lee, Geon-Cheol (Department of Physical Theraphy, Kyungnam College University of Information & Technology)
  • 이종화 (동아대학교 의과대학 재활의학교실 및 동아대학교병원 권역심뇌혈관질환센터) ;
  • 김상범 (동아대학교 의과대학 재활의학교실 및 동아대학교병원 권역심뇌혈관질환센터) ;
  • 이경우 (동아대학교 의과대학 재활의학교실 및 동아대학교병원 권역심뇌혈관질환센터) ;
  • 김병희 (동아대학교 의과대학 재활의학교실 및 동아대학교병원 권역심뇌혈관질환센터) ;
  • 김민아 (동아대학교 의과대학 재활의학교실 및 동아대학교병원 권역심뇌혈관질환센터) ;
  • 이건철 (KIT 경남정보대학 물리치료과)
  • Received : 2009.12.03
  • Accepted : 2010.04.28
  • Published : 2010.08.31
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Abstract

Objective: To evaluate the incidence, associated neuropsychological symptoms, imaging feature and prognosis of pusher syndrome (PS). Method: One hundred-ninety-seven patients with unilateral acute stroke were enrolled. Patients were evaluated for the presence and severity of PS using a standardized scale for contraversive pushing, neurological examination, assessment of neuropsychological symptoms (neglect, anosognosia, aphasia, apraxia), activities of daily living (ADL) and neuroimaging studies (CT or MRI). ADL was measured with Korean version of modified Barthel index (K-MBI). Results: PS was found in 10.7% (n=21) of the included patients. No significant differences were found between patients with and without PS in age, sex, handedness, initial K-MBI score, neuropsychologic symptoms, lesion size and cortical involvement. Thalamic lesion was strongly correlated with PS (p<0.05). PS had no independent influence on gain in ADL, but spent 4.8${\pm}$1.7 weeks (p<0.05) more to reach the same final outcome level than did patients without PS. Average symptom duration of PS was 14.6${\pm}$3.6 weeks. Initial severity of PS did not influence on gain in ADL and recovery period. Conclusion: PS did not affect final functional outcome, but slowed the process of recovery considerably. And thalamus seems to be fundamentally involved in control of upright body posture. Presence of PS is more important than severity of initial PS for prognosis.

Keywords

References

  1. Dettmann MA, Linder MT, Sepic SB. Relationships among walking performance, postural stability, and functional assessments of the hemiplegic patient. Am J Phys Med 1987; 66: 77-90
  2. Spinazzola L, Cubelli R, Della Sala S. Impairments of trunk movements following left or right hemisphere lesions: dissociation between apraxic errors and postural instability. Brain 2003; 126: 2656-2666 https://doi.org/10.1093/brain/awg266
  3. Davies PM. Steps to follow: A guide to the treatment of adult hemiplegia, 1st ed, Berlin: Springer-Verlag, 1985, 266-284
  4. Karnath HO, Broetz D. Understanding and treating "pusher syndrome". Phys Ther 2003; 83: 1119-1125
  5. Karnath HO. Pusher syndrome--a frequent but little-known disturbance of body orientation perception. J Neurol 2007; 254: 415-424 https://doi.org/10.1007/s00415-006-0341-6
  6. Pedersen PM, Wandel A, Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS. Ipsilateral pushing in stroke: incidence, relation to neuropsychological symptoms, and impact on rehabilitation. The Copenhagen stroke study. Arch Phys Med Rehabil 1996; 77: 25-28 https://doi.org/10.1016/S0003-9993(96)90215-4
  7. Danells CJ, Black SE, Gladstone DJ, McIlroy WE. Poststroke "pushing": natural history and relationship to motor and functional recovery. Stroke 2004; 35: 2873-2878 https://doi.org/10.1161/01.STR.0000147724.83468.18
  8. Lafosse C, Kerckhofs E, Troch M, Vereeck L, Van Hoydonck G, Moeremans M, Broeckx J, Vandenbussche E. Contraversive pushing and inattention of the contralesional hemispace. J Clin Exp Neuropsychol 2005; 27: 460-484 https://doi.org/10.1080/13803390490520463
  9. Karnath HO, Ferber S, Dichgans J. The neural representation of postural control in humans. Proc Natl A cad Sci USA 2000; 97: 13931-13936 https://doi.org/10.1073/pnas.240279997
  10. Karnath HO, Johannsen L, Broetz D, Ferber S, Dichgans J. Prognosis of contraversive pushing. J Neurol 2002; 249: 1250-1253 https://doi.org/10.1007/s00415-002-0824-z
  11. Karnath HO, Broetz D, Gotz A. Clinical symptoms, origin, and therapy of the "pusher syndrome". Nervenarzt 2001; 72: 86-92 https://doi.org/10.1007/s001150050719
  12. Butter CM, Evans J, Kirsch N, Kewman D. Altitudinal neglect following traumatic brain injury: a case report. Cortex 1989; 25: 135-146 https://doi.org/10.1016/S0010-9452(89)80013-9
  13. Albert ML. A simple test of visual neglect. Neurology 1973; 23: 658-664 https://doi.org/10.1212/WNL.23.6.658
  14. Fullerton KJ, Mcsherry D, Stout RW. Albert's test: a neglected test of perceptual neglect. Lancet 1986; 22: 430-432
  15. Folstein MF, Folstein SE, McHugh PR. "Mini-Mental state". A practical method for grading the cognitive state of patients fot the clinician. J Psychiatr Res 1975; 12: 189-198 https://doi.org/10.1016/0022-3956(75)90026-6
  16. Bisiach E, Vallar G, Perani D, Papagno C, Berti A. Unawareness of disease following lesions of the right hemisphere: anosognosia for hemiplegia and anosognosia for hemianopia. Neuropsychologia 1986; 24: 471-482 https://doi.org/10.1016/0028-3932(86)90092-8
  17. Korea Dementia Association. 2007 The early examination project of Dementia 2nd instruction book. Seoul: KGA, 2007, 110
  18. Helm-Estabrook N. Test of oral and limb apraxia, 1st ed, Chicago: Riverside Publishing Company, 1992, 112-118
  19. Karnath HO, Johannsen L, Broetz D, Küker W. Posterior thalamic hemorrhage induces "pusher syndrome". Neurology 2005; 64: 1014-1019 https://doi.org/10.1212/01.WNL.0000154527.72841.4A
  20. Johannsen L, Broetz D, Naegele T, Karnath HO. "Pusher syndrome" following cortical lesions that spare the thalamus. J Neurol 2006; 253: 455-463 https://doi.org/10.1007/s00415-005-0025-7
  21. Rorden C, Karnath HO. Using human brain lesions to infer function: a relic from a past era in the fMRI age? Nat Rev Neurosci 2004; 5: 813-819
  22. Karnath HO, Ferber S, Dichgans J. The origin of contraversive pushing: evidence for a second graviceptive system in humans. Neurology 2000; 55: 1298-1304 https://doi.org/10.1212/WNL.55.9.1298
  23. Pontelli TE, Pontes-Neto OM, Colafemina JF, Araujo DB, Santos AC, Leite JP. Posture control in Pusher syndrome: influence of lateral semicircular canals. Braz J Otorhinolaryngol 2005; 71: 448-452 https://doi.org/10.1016/S1808-8694(15)31197-6
  24. Bisdorff AR, Wolsley CJ, Anastasopoulos D, Bronstein AM, Gresty MA. The perception of body verticality (subjective postural vertical) in peripheral and central vestibular disorders. Brain 1996; 119: 1523-1534 https://doi.org/10.1093/brain/119.5.1523