Body Lateropulsion With Involvement of the Medial Lemniscus Due to a Middle Pontine Tegmentum Infarction

Abstract

A 53-year-old man with essential hypertension abruptly developed rightward body lateropulsion (BL), and mild dysesthesia in the right upper extremity. No other neurologic abnormalities were observed. Cranial magnetic resonance imaging demonstrated a small infarct lesion in the middle pontine tegmentum on the left side. Under anti-platelet agent, the patient became asymptomatic within 7 days. BL is defined as irresistible falling to one side without motor weakness. Damage to the ascending graviceptive pathway (GP) may cause BL. GP from the vestibular nuclei to the Cajal interstitial nucleus crosses the midline in the caudal pons. Based on previous reports, the location of GP was speculated in the rostral pons. However, its precise location remains unreported in the middle pons. This is a second reported case of BL due to a middle pontine tegmentum infarction. In addition, findings of neurologic and magnetic resonance imaging in our patient suggest that GP may run in the dorsal region to the medial lemniscus in the middle pons. J Med Cases. 2014;5(1):43-44 doi: http://dx.doi.org/10.4021/ jmc1612w