| Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship? | |
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MedLine Citation:
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PMID: 18678565 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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The relationships between perception of verticality by different sensory modalities, lateropulsion and pushing behaviour and lesion location were investigated in 86 patients with a first stroke. Participants sat restrained in a drum-like framework facing along the axis of rotation. They gave estimates of their subjective postural vertical by signalling the point of feeling upright during slow drum rotation which tilted them rightwards-leftwards. The subjective visual vertical was indicated by setting a line to upright on a computer screen. The haptic vertical was assessed in darkness by manually setting a rod to the upright. Normal estimates ranged from -2.5 degrees to 2.5 degrees for visual vertical and postural vertical, and from -4.5 degrees to 4.5 degrees for haptic vertical. Of six patients with brainstem stroke and ipsilesional lateropulsion only one had an abnormal ipsilesional postural vertical tilt (6 degrees ); six had an ipsilesional visual vertical tilt (13 +/-.4 degrees ); two had ipsilesional haptic vertical tilts of 6 degrees . In 80 patients with a hemisphere stroke (35 with contralesional lateropulsion including 6 'pushers'), 34 had an abnormal contralesional postural vertical tilt (average -8.5 +/- 4.7 degrees ), 44 had contralesional visual vertical tilts (average -7 +/- 3.2 degrees ) and 26 patients had contralesional haptic vertical tilts (-7.8 +/- 2.8 degrees ); none had ipsilesional haptic vertical or postural vertical tilts. Twenty-one (26%) showed no tilt of any modality, 41 (52%) one or two abnormal modality(ies) and 18 (22%) a transmodal contralesional tilt (i.e. PV + VV + HV). Postural vertical was more tilted in right than in left hemisphere strokes and specifically biased by damage to neural circuits centred around the primary somatosensory cortex and thalamus. This shows that thalamo-parietal projections have a functional role in the processing of the somaesthetic graviceptive information. Tilts of the postural vertical were more closely related to postural disorders than tilts of the visual vertical. All patients with a transmodal tilt showed a severe lateropulsion and 17/18 a right hemisphere stroke. This indicates that the right hemisphere plays a key role in the elaboration of an internal model of verticality, and in the control of body orientation with respect to gravity. Patients with a 'pushing' behaviour showed a transmodal tilt of verticality perception and a severe postural vertical tilt. We suggest that pushing is a postural behaviour that leads patients to align their erect posture with an erroneous reference of verticality. |
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Authors:
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D A Pérennou; G Mazibrada; V Chauvineau; R Greenwood; J Rothwell; M A Gresty; A M Bronstein |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't Date: 2008-08-04 |
Journal Detail:
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Title: Brain : a journal of neurology Volume: 131 ISSN: 1460-2156 ISO Abbreviation: Brain Publication Date: 2008 Sep |
Date Detail:
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Created Date: 2008-08-27 Completed Date: 2008-10-06 Revised Date: 2008-11-21 |
Medline Journal Info:
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Nlm Unique ID: 0372537 Medline TA: Brain Country: England |
Other Details:
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Languages: eng Pagination: 2401-13 Citation Subset: AIM; IM |
Affiliation:
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Clinique de Médecine Physique et Réadaptation, Hôpital Nord-CHU Grenoble, Université Grenoble 1 degrees, Unité de Rééducation Neurologique du Grau du Roi, CHU Nîmes, France. DPerennou@chu-grenoble.fr |
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Brain Stem / pathology Female Gravity Sensing Humans Male Middle Aged Orientation* Posture Proprioception* Rotation Space Perception* Stroke / pathology, physiopathology, psychology* |
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