Posterior Pusher Syndrome – Case Report

Abstract

Background. Pusher syndrome is classically described as frequent but little-known disorder of body orientation characterized by a tilt towards the contralesional paretic side and a resistance to external attempts to rectify. Pusher syndrome occurs mainly in stroke patients, but non-stroke causes have been described too. In 2010 was proposed concept of the posterior pusher syndrome, defined as disturbance of body orientation in the sagittal plane with imbalance, posterior tilt and an active resistance to forward pulling or pushing. Aim of this study is to familiarize readers with the assessment and treatment of the little known posterior pusher syndrome.
Case study. The patient was sixty-seven-year-old female, eight weeks after an ischemic stroke, with left hemiplegia. Posterior pusher syndrome was diagnosed next week. Introduced adequate therapy (25 sessions) caused recovery in the area of posterior pusher syndrome symptoms.
Discussion. Number of patients with misdiagnosed pusher syndrome (contralateral or posterior) remains unknown. Knowledge in the area of assessment and possibilities of the treatment among medical staff is important due to significant influence of the pusher syndrome to the effectivity and time of the recovery.
Conclusions. Effective ways of therapy in patients with diagnosed posterior pusher syndrome’ therapy are similar to the therapy in patients with contralesional pusher syndrome, taking into consideration changed direction of pushing/tilt. Further research into the neurophysiological basis, incidence, assessment and therapy of the described syndrome is perceived very important issue. (PNN 2013;2(3):125-129)