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Europa Medicophysica 2001 September;37(3):143-51

Copyright © 2001 EDIZIONI MINERVA MEDICA

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


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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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