Abstract
We aimed to explore whether motor function and activities of daily life (ADL) could be improved with the application of visual deprivation in two patients with Pusher syndrome complicated by hemispatial neglect after right basal ganglia stroke. We assessed two stroke patients suffering from severe motor disturbances, both tilting heavily to the left, with diagnoses of Pusher syndrome and left hemispatial neglect. Vision in the left eye was deprived using patches during clinical rehabilitation. Motor function promotion was confirmed using the Burke Lateropulsion Scale (BLS), Fugl–Meyer Balance Scale (FMBS), and Holden grade (HG), while the Barthel index (BI) assessed ADL immediately and 1 week after intervention. Both patients regained standing balance immediately using visual deprivation, as well as walking ability, although both scored 0 on the FMBS and HG. After 1 week of treatment, one patient increased to 11 and 3 on the FMBS and HG, respectively, while the BLS score decreased from 12 to 2, and the ADL increased from 23 to 70. The other patient demonstrated increases to 10 and 3 on the FMBS and HG, respectively, with the BLS decreasing from 13 to 3, and the ADL increasing from 25 to 60. Therefore, in the rehabilitation treatment of Pusher syndrome complicated by hemispatial neglect due to basal ganglia stroke, visual deprivation can significantly improve motor function and shorten the treatment course.
Highlights
Pusher syndrome (PS), known as “tilt syndrome,” is a severe postural control disorder that occurs after stroke and is characterized by uncorrectable balance dysfunction
Several studies have found that brain regions such as the posterior and lateral ventral nuclei of the thalamus, insular cortex, and part of the parietal lobe [20, 21] are associated with PS pathogenesis
More recent studies have shown that a coherent cortico-subcortical network comprising the right superior temporal gyrus, putamen, and caudate nucleus performs the cognitive processing functions of spatial perception and consciousness [22]
Summary
Pusher syndrome (PS), known as “tilt syndrome,” is a severe postural control disorder that occurs after stroke and is characterized by uncorrectable balance dysfunction. A 65-year-old male farmer was admitted to the hospital 17 days after a cerebral infarction He presented with a severe tilt to the left and was unable to sit or stand unaided. When he turned his head and neck to the right, both eyes rotated right His ability to receive stimuli from the left side was significantly decreased, and both sitting and standing balance could not be maintained. After 1 week of treatment, the patient could walk under supervision for a short distance indoors without visual deprivation His BLS improved to 3, FMBS improved to 10, HG improved to 3 (i.e., walking under supervision), and BI improved to 60 (Figure 3). At the time of discharge after 4 weeks of treatment in total, the patient was able to walk approximately 200 m continuously indoors, but still required supervision
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