Pushing behavior and hemiparesis: which is critical for functional recovery in pusher patients ? Case report

We report a sequential neuroimaging study in a 48-years-old man with a history of chronic hypertension and lacunar strokes involving the ventral lateral posterior nucleus of the thalamus. The patient developed mild hemiparesis and severe contraversive pushing behavior after an acute hemorrhage affec...

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Bibliographic Details
Published in:Arquivos de neuro-psiquiatria 2007-06, Vol.65 (2B), p.536-539
Main Authors: Santos-Pontelli, Taiza E G, Pontes-Neto, Octávio M, Colafêmina, José Fernando, Araújo, Dráulio B de, Santos, Antônio Carlos, Leite, João P
Format: Article
Language:English
Subjects:
Disability Evaluation
Female
Functional Laterality
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Movement Disorders - etiology
Movement Disorders - rehabilitation
NEUROSCIENCES
Paresis - etiology
Paresis - rehabilitation
PSYCHIATRY
Recovery of Function
Severity of Illness Index
Stroke - complications
Stroke Rehabilitation
Syndrome
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Summary:We report a sequential neuroimaging study in a 48-years-old man with a history of chronic hypertension and lacunar strokes involving the ventral lateral posterior nucleus of the thalamus. The patient developed mild hemiparesis and severe contraversive pushing behavior after an acute hemorrhage affecting the right thalamus. Following standard motor physiotherapy, the pusher behavior completely resolved 3 months after the onset and, at that time, he had a Barthel Index of 85, although mild left hemiparesis was still present. This case report illustrates that pushing behavior itself may be severely incapacitating, may occur with only mild hemiparesis and affected patients may have dramatic functional improvement (Barthel Index 0 to 85) after resolution pushing behavior without recovery of hemiparesis.
ISSN:0004-282X
1678-4227
0004-282X
DOI:10.1590/S0004-282X2007000300035