In contrast to most stroke patients, who typically prefer more weight-bearing on their nonhemiparetic side, this abnormal condition can vary in severity and leads to a loss of postural balance. The lesion involved in this syndrome is thought to be in the posterior thalamus on either side, or multiple areas of the right cerebral hemisphere.With a diagnosis of pusher behaviour, three important variables should be seen, the most obvious of which is spontaneous body posture of a longitudinal tilt of the torso toward the paretic side of the body occurring on a regular basis and not only on occasion. The use of the nonparetic extremities to create the pathological lateral tilt of the body axis is another sign to be noted when diagnosing for pusher behaviour. This includes abduction and extension of the extremities of the non-affected side, to help in the push toward the affected (paretic) side. The third variable that is seen is that attempts of the therapist to correct the pusher posture by aiming to realign them to upright posture are resisted by the patient.In patients with acute stroke and hemiparesis, the disorder is present in 10.4% of patients. Rehabilitation may take longer in patients that display pusher behaviour. The Copenhagen Stroke Study found that patients that presented with ipsilateral pushing used 3.6 weeks more to reach the same functional outcome level on the Barthel Index, than did patients without ipsilateral pushing.Pushing behavior has shown that perception of body posture in relation to gravity is altered.
Treatment
Antiviral therapy, such as acyclovir and ganciclovir, work best when applied as early as possible. May also be treated with interferon as an immune therapy. Symptomatic therapy can be applied as needed. High fever can be treated by physical regulation of body temperature. Seizure can be treated with antiepileptic drugs. High intracranial pressure can be treated with drugs such as mannitol. If caused by an infection then the infection can be treated with antibiotic drugs. See also
Meningitis
Meningism
Primary amoebic meningoencephalitis
Encephalitis
Naegleria fowleri

References


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