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From Section Neuropsychology (Dr. Karnath, and L. Johannsen and D. Broetz), Department of Cognitive Neurology, Hertie-Institute for Clinical Brain Research, and Department of Neuroradiology (Dr. Küker), University of Tübingen, Germany. Dr. Küker is currently affiliated with the Department of Neuroradiology, Radcliffe Infirmary, Oxford, UK.
Address correspondence and reprint requests to Prof. Hans-Otto Karnath, Center of Neurology, University of Tübingen, Hoppe-Seyler-Str. 3, D-72076 Tübingen, Germany; e-mail: Karnath{at}uni-tuebingen.de
Background: Recent findings argue for a pathway in humans for sensing the orientation of gravity and controlling upright body posture, separate from the one for orientation perception of the visual world. Stroke patients with contraversive pushing were shown to experience their body as oriented upright when actually tilted about 20° to the ipsilesional side, in spite of normal visual-vestibular functioning. A recent study suggested the involvement of posterolateral thalamus typically associated with the disorder.
Objective: To evaluate the relationship between pushing behavior and thalamic function.
Methods: Over a 3-year period the authors prospectively investigated 40 patients with left- or right-sided thalamic strokes.
Results: Twenty-eight percent showed contraversive pushing. The authors found a strong relationship between etiology, vascular territory, lesion size, and neurologic disorders associated with contraversive pushing. Pusher patients had larger lesions that typically were caused by hemorrhage (vs infarcts) located in the posterior thalamus (vs anterior thalamic lesions in those patients without pushing behavior). A paresis of the contralesional extremities was more frequent and more severe in pusher patients. Further, these patients showed more additional spatial neglect with right thalamic lesions, while they tended to be more aphasic with left thalamic lesions.
Conclusions: Posterior thalamus seems to be fundamentally involved in our control of upright body posture. Higher pressure, swelling, and other secondary pathologic processes associated with posterior thalamic hemorrhage (vs thalamic infarction) may provoke contraversive pushing in combination with additional neurologic symptoms.
Supported by grants from the Deutsche Forschungsgemeinschaft (Ka 1258, Graduiertenkolleg Kognitive Neurobiologie).
Received September 21, 2004. Accepted in final form November 17, 2004.
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  D. A. Perennou, G. Mazibrada, V. Chauvineau, R. Greenwood, J. Rothwell, M. A. Gresty, and A. M. Bronstein Lateropulsion, pushing and verticality perception in hemisphere stroke: a causal relationship? Brain, September 1, 2008; 131(9): 2401 - 2413. [Abstract] [Full Text] [PDF]
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 S. R. Babyar, K. H. McCloskey, and M. Reding Surface Electromyography of Lumbar Paraspinal Muscles During Seated Passive Tilting of Patients With Lateropulsion Following Stroke Neurorehabil Neural Repair, March 1, 2007; 21(2): 127 - 136. [Abstract] [PDF]
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 J. C. Masdeu, P. B. Gorelick, H.-O. Karnath, L. Johannsen, D. Broetz, and W. Kuker Posterior thalamic hemorrhage induces "pusher syndrome" Neurology, November 22, 2005; 65(10): 1682 - 1682. [Full Text] [PDF]
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