Isolated lateropulsion of the trunk in cerebellar infarct

Isolated axial lateropulsion caused by an acute lateral medullary infarction involving the dorsal spinocerebellar tract: A case report

Lateral medullary syndrome encompasses a broad spectrum of symptoms and signs depending on the bulbar localization of the lesion. Body lateropulsion (BL) can occur without vestibular and cerebellar symptoms, as a unique manifestation of a lateral medullary infarction. However, it is relatively rare and challenging to diagnose. We report a case of a 72-year-old woman who presented with a tendency to fall to the right. She denied having vertigo, cerebellar signs, sensory loss, or motor weakness. No signs of vestibular dysfunction were found on the ENT examination. Neurological evaluation was unremarkable, except for mild ataxia of the right limbs along with BL to the right side when standing and walking. Brain magnetic resonance (MR) imaging showed an acute small infarct in the right lateral aspect of the medulla extending from the rostral to the caudal level. MR angiography found no stenosis or vascular occlusions. We believe that ipsilateral axial lateropulsion shown by our patient may be related to a selective ischemic lesion of the dorsal spinocerebellar tract in its medullary course. A lateral medullary infarction should be seriously considered in patients who present with isolated BL without further signs of bulbar involvement.

Isolated hemorrhage in the cerebellar vermis with vertigo and body lateropulsion to the contralesional side

There have been several reports of patients with isolated lesions of the cerebellar vermis presenting with clinical features similar to those of peripheral vestibulopathy. We report a case of small, isolated hematoma in the cerebellar vermis in a patient who presented with vertigo, ipsilesional nystagmus, and body lateropulsion to the contralesional side without the usual signs or symptoms of cerebellar dysfunction. Although they present with symptoms that mimic those of peripheral vestibulopathy, and brain computed tomography shows no abnormality, as there may be a small, isolated hematoma or infarction in the cerebellar vermis. Thus, brain magnetic resonance imaging should be performed in elderly patients with vascular risk factors.

Body Lateropulsion and Cerebellar Tremor in a Patient with Pontine Infarction

Body lateropulsion is known to be caused commonly by lateral medullary lesions but rarely by pontine lesions. It is also known to be associated with lesions of the dorsal spinothalamic tract or ascending graviceptive pathways. We herein report the case of a 75-year-old woman presenting with contralateral lateropulsion and cerebellar tremor caused by pons infarction. To our knowledge, this is the first case report of pontine infarction causing both lateropulsion and cerebellar tremor. Our case may be helpful in anatomical studies of ascending graviceptive pathways.

Isolated body lateropulsion in a patient with pontine infarction

A 72-year-old man with diabetes mellitus and hypertension was admitted to our hospital with lightheadedness. The patient showed lateropulsion to the right side, but his neurological findings were otherwise normal. Brain magnetic resonance images showed a fresh ischemic infarct in the left dorsal part of the lower pons. Body lateropulsion is characterized by an irresistible falling to one side and has been reported in lesions in several brain regions. However, it has rarely been reported in pontine lesions. We suggest that physicians should be aware that pontine lesions can cause isolated body lateropulsion without other neurological deficits.

Isolated body lateropulsion caused by a lesion of the rostral vermis

A 66-year-old man presented with axial lateropulsion, exhibiting sudden falling as the sole clinical sign of cerebellar infarction in the territory of the medial branch of the superior cerebellar artery (mSCA). A brain MRI showed acute infarction selectively involving the centralis of the rostral vermis. This patient illustrates that cerebellar infarction in the territory of the mSCA can present as an isolated body lateropulsion. The possible mechanism of an isolated body lateropulsion is considered.

The clinical variability of Wallenberg's syndrome

The dorso-lateral medullary syndrome (Wallenberg's syndrome) is produced by infarction of a wedge of lateral medulla posterior to the inferior olivary nucleus and is usually caused by vertebral artery occlusion. Ipsilateral axial lateropulsion as an initial symptom of vertebral artery occlusion is rather rare and the anatomical structure responsible is still uncertain. Here we describe two patients presenting with ipsilateral axial lateropulsion as an initial symptom of vertebral artery occlusion. In one the stroke affected the dorso-lateral aspect of the medulla, in the other more lateral aspects of the medulla were involved. Our data suggest that ipsilateral axial lateropulsion may be caused by lesions of different topography involving either the vestibular nuclei, the cerebellar peduncle or the spinocerebellar tracts.