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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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Europa Medicophysica 2001 September;37(3):143-51

language: English

Pusher syn­drome in ­stroke: clin­ical, neu­ro­psy­cho­log­ical and neu­ro­phys­io­log­ical inves­ti­ga­tion

Premoselli S., Cesana L. *, Cerri C.

From the U. O. Neu­ro­ri­a­bil­i­taz­ione, Azienda Osped­a­liera di Vim­er­cate, Pre­sidio di ­Seregno, Università ­degli ­Studi ­Milano-­Bicocca, ­Milano
*Ser­vizio di Recu­pero e Rie­du­caz­ione Fun­zi­o­nale, RSA, G. ­Verdi, ­Milano


Back­ground. ­Pusher syn­drome i.e. the ten­dency of ­patients to ­push ­towards the hem­i­plegic ­side, is ­quite com­monly ­observed in neu­ro­re­ha­bil­i­ta­tion ­units. Nev­er­the­less ­little ­research has ­been car­ried out to ­clarify fac­tors ­that con­tribute to ­create ­such clin­ical con­di­tion. We exam­ined the influ­ence of cog­ni­tive and neu­ro­phys­io­log­ical impair­ment in pro­ducing the syn­drome.
­Methods. Two ­groups of ­patients ­with (22 ­patients) and ­without (12 ­patients) ­pushing beha­viour ­were con­sid­ered. Func­tional Indi­pen­dence ­Measure (FIM), eval­u­a­tion of ­pushing beha­viour and a neu­ro­log­ical exam­ina­tion was per­formed in all ­patients. Neu­ro­psy­cho­log­i­cally 16 ­patients ­with ­pushing beha­viour ­were ­assessed ­using ­Mini ­Mental ­State Exam­ina­tion (­MMSE), ­tests for all ­type of ­neglect, and ­tests for hem­i­spa­tial aki­nesia, endo­ev­oked direc­tional aki­nesia and ­motor imper­sis­tence. Tac­tile, ­visual and audi­tory extinc­tion was con­sid­ered too. Som­a­tos­en­sory ­evoked poten­tials (­SSEP) laten­cies and ampli­tudes of pos­te­rior ­tibial ­nerve and ­sural ­nerve sen­sory ­action poten­tial (SAP) laten­cies and ampli­tudes ­were meas­ured in all ­patients.
­Results. TC exam­ina­tion ­pusher ­group ­showed ­more ­that one local­iza­tion, cor­tical and sub­cor­tical ­lesions, ­with a prev­a­lence of ­right hem­i­sphere involve­ment. Per­sonal ­neglect, ­motor imper­sis­tence, audi­tory and ­visual extinc­tion ­appeared ­clearly cor­re­lated to ­pushing beha­viour ­severity. ­Lack of sta­tis­tical evi­dence ­regarding fre­quen­cies of path­o­log­ical ­SSEP laten­cies of ­sound ­side in the two ­groups ­seem to ­rule out ­that sen­si­tive affer­ences ­from the ­sound ­side ­form a pecu­liar clin­ical fea­ture, ­although com­par­ison ­between ­SSEP laten­cies of two hem­i­sides ­within ­single ­groups (­pusher, no-­pusher) ­point out ­that in ­pusher ­group ­doesn’t ­exist expres­sive dif­fer­ence ­between laten­cies of two hem­i­sides ­because prob­able ­increasing of ­SSEP ­latency of ­sound ­side.
Con­clu­sions. In con­clu­sion our find­ings ­seem to sup­port the hypoth­esis ­that ­internal ­body rep­re­sen­ta­tion def­i­cits asso­ciated ­with atten­tional dis­or­ders (imper­si-s­tence) and ­residual ­neglect impair­ment (­visual and audi­tory extinc­tion) ­play an impor­tant ­role in the ­severity of ­pushing beha­viour.

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