Contraversive pushing in non-stroke patients.
BACKGROUND
Pusher syndrome is a disorder of postural control observed in patients with right or left brain damage associated with hemiparesis. Those patients show a peculiar behavior of actively pushing away from the nonhemiparetic side and resisting against passive correction, with a tendency to fall toward the paralyzed side. Thus far this phenomenon has been exclusively associated with stroke patients.


OBJECTIVE
We investigate the occurrence, imaging features and clinical evolution of pusher behavior in patients with acute encephalic lesions at a tertiary emergency hospital.


METHODS
Pusher patients were identified from 530 inpatients during a 1 year period. Patients were evaluated using a standardized Scale for Contraversive Pushing (SCP), neurological examination, assessment of neuropsychological symptoms, activities of daily living function and neuroimaging studies.


RESULTS
We found eight patients (1.5%) with severe contraversive pushing, three female and five male. Age at symptoms onset ranged from 48 to 80 years (mean 65.4). All patients had scores equal or above 1.5 in each tested parameter of the SCP. Six patients (75 %) had right-hemisphere brain damage. A stroke etiology was found in four patients. The other four patients had non-stroke etiology (three traumatic, one metastatic tumor). Stroke patients showed complete recovery of pusher behavior at a mean duration of 15.3 weeks. In patients with brain trauma, pushing behavior was completely resolved in a mean time of 5 weeks.


CONCLUSIONS
The results demonstrate that contraversive pushing may also occur in patients with non-stroke neurological lesions and suggest that resolution of symptoms may vary according to the underlying etiology.
Santos-Pontelli
Taiza E G
TE
Dept. of Neurology, University of São Paulo, School of Medicine at Ribeirão Preto, Campus Universitário, Ribeirão Preto, CEP 14049-900, Brazil.
Pontes-Neto
Octávio M
OM
Colafêmina
José Fernando
JF
de Araujo
Dráulio B
DB
Santos
Antônio Carlos
AC
Leite
João P
JP
D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010291:Paresis / Q000473:pathology / Q000503:physiopathology*; D011187:Posture; D013577:Syndrome; D014057:Tomography, X-Ray Computed / Q000379:methods