Body Lateropulsion as a Presenting Symptom of Rostral Paramedian Midbrain Syndrome

Abstract

Dear Sir, Lateropulsion of the body is the occurrence of an irresistible fall in individuals without vertigo, paresis, sensory loss, or cerebellar deficits [1] . It is a well-known clinical feature of the lateral medullary infarction, but other lesions with cerebellum, midbrain, thalamus, and pons could also result in body lateropulsion [2–6] . Body lateropulsion is usually associated with other neurological symptoms or signs, which vary according to the structures involved. Vestibular dysfunction in the roll plane of the vestibulo-ocular reflex is responsible for body lateropulsion in most cases [2] . There have been only few reports [7, 8] on body lateropulsion as a presenting symptom of rostral midbrain infarction. Furthermore, previous reports [7, 8] have not emphasized the vestibular dysfunction as a possible mechanism of body lateropulsion and did not perform a quantitative posturography test to investigate the mechanism of gait dysfunction. I present a patient who had body lateropulsion as the presenting feature of a small infarct in the rostral paramedian midbrain and discuss the possible mechanism of body lateropulsion at the level of the rostral midbrain.