Lateropulsion After Hemispheric Stroke: A Form of Spatial Neglect Involving Graviception.

OBJECTIVE To test the hypothesis that lateropulsion is an entity expressing an impaired body orientation with respect to gravity, in relation to a biased graviception and spatial neglect. METHODS Data from the DOBRAS cohort (ClinicalTrials.gov:NCT03203109), were collected 30 days after a first hemisphere stroke. Lateral body tilt, pushing and resistance were assessed with the Scale for Contraversive Pushing. RESULTS Among 220 individuals, 72% were Upright and 28% showed lateropulsion (Tilters=14% less severe than Pushers=14%). The three signs had very high factor loadings (>0.90) on a same dimension, demonstrating that lateropulsion was effectively an entity comprising body tilt (cardinal sign), pushing and resistance. The factorial analyses also showed that lateropulsion was inseparable from the visual vertical (VV), a criterion referring to vertical orientation (graviception). Contralesional VV biases were frequent (44%), with a magnitude related to lateropulsion severity: Upright -0.6°(-2.9;2.4), Tilters -2.9°(-7;0.8), Pushers -12.3°(-15.4;-8.5). Ipsilesional VV biases were less frequent and milder (p<0.001). They did not deal with graviception, 84% being found in upright individuals. Multivariate, factorial, contingency, and prediction analyses congruently showed strong similarities between lateropulsion and spatial neglect, the latter encompassing the former. CONCLUSIONS Lateropulsion (pusher syndrome) is a trinity constituted by body tilt, pushing and resistance. It is a way to adjust the body orientation in the roll plane to a wrong reference of verticality. Referring to straight above, lateropulsion might correspond to a form of spatial neglect (referring to straight ahead), which would advocate for 3-D maps in the human brain involving the internal model of verticality.