Characteristics and Prognosis of Pusher Syndrome in Stroke Patients

ABSTRACT

OBJECTIVE: To evaluate the incidence, associated neuropsychological symptoms, imaging feature and prognosis of pusher syndrome (PS). METHOD: One hundred-ninety-seven patients with unilateral acute stroke were enrolled. Patients were evaluated for the presence and severity of PS using a standardized scale for contraversive pushing, neurological examination, assessment of neuropsychological symptoms (neglect, anosognosia, aphasia, apraxia), activities of daily living (ADL) and neuroimaging studies (CT or MRI). ADL was measured with Korean version of modified Barthel index (K-MBI). RESULTS: PS was found in 10.7% (n=21) of the included patients. No significant differences were found between patients with and without PS in age, sex, handedness, initial K-MBI score, neuropsychologic symptoms, lesion size and cortical involvement. Thalamic lesion was strongly correlated with PS (p<0.05). PS had no independent influence on gain in ADL, but spent 4.8+/-1.7 weeks (p<0.05) more to reach the same final outcome level than did patients without PS. Average symptom duration of PS was 14.6+/-3.6 weeks. Initial severity of PS did not influence on gain in ADL and recovery period. CONCLUSION: PS did not affect final functional outcome, but slowed the process of recovery considerably. And thalamus seems to be fundamentally involved in control of upright body posture. Presence of PS is more important than severity of initial PS for prognosis.