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J Neurol (2012) 259:14681469 DOI 10.1007/s00415-011-6348-7
LETTER TO THE EDITORS
Pusher syndrome in patients with cerebellar infarctions?
Bernhard Baier Marianne Dieterich
Received: 17 October 2011 / Revised: 29 November 2011 / Accepted: 30 November 2011 / Published online: 22 December 2011 Springer-Verlag 2011
Dear Sirs,
Acute supratentorial unilateral stroke can lead to an impairment of head and body posture and balance that manifests as an active pushing away from the non-paralyzed side in order to maintain an upright posture, i.e., so-called pusher syndrome (PS). Besides supratentorial lesions [13], there have also been claims of PS occurring in patients with cerebellar lesions [4]. Thus, we aimed to answer the question whether the PS can be found regularly in patients with cerebellar lesions.
A total of 19 patients with acute cerebellar stroke, documented by magnetic resonance imaging (MRI) (time since lesion, mean standard deviation (SD): 4.0 2.2 days) were classied based on the criteria of the Scale for Contraversive Pushing [1]. All patients underwent neurootological examinations including otolith testing by means of the subjective visual vertical (SVV) [5, 6].
None of the patients showed PS (mean score 0). However, if the criterion of a pathological tilt of SVV of [2.5 on our data is applied [5], 9 patients (48%) presented with contralesional tilt (9.1 7.1) and 5 (26%) with ipsilesional tilt of SVV (5.1 2.9). Five patients (26%) had no pathological tilt.
Thus, our data indicate that PS is not a common sign in patients with acute cerebellar lesions, whereas an otolith decit with tilts of SVV regularly occurred [6]. Therefore,
contrary to a cortical level where an association between PS and SVV tilt was reported [3, 7] and points toward otolith dysfunction in PS patients, at a cerebellar level such an association...