Questions posted in the
Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.
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Subject: Re: pushers syndrome I am a PT graduate student at Nova Southeastern university. I am currently doing a nursing home clinical rotation. One of my cva patients is prestenting "pushing syndrome" on his less-affected side. His left affected side will grab and hold onto anything, his L arm and L leg will involuntarilypush off the chair, bed and floor. I have searched the medical data bases and found little on this hypertonic muscle response. Any suggestions of where else to look? Is this a manifistation of a primitive response or select spasticity? --------------------------------------------------------------------------- Hello John! I am not aware of a specific entity of "pusher's syndrome", however, spasticity with frequent involuntary contraction of the affected muscles after the stroke is certainly a well recognized complication of stroke. Such involuntary spasms can often be triggered by the slightest stretch of the affected muscles, such as when they touch the floor or a wall. If you place your hand on your patient's foot and exert a small amount of force you could probably trigger a similar response, as if he or she was withdrawing from your hand like it was fire. It can sometimes be controlled by the use of Valium, tizanidine, baclofen, or in extreme cases intrathecal (into the cerebrospinal fluid) baclofen via a pump. Involuntary grabbing onto things placed into the hand )or foot in severe cases) is known as grasping, and is a nonspecific sign of diffuse frontal lobe damage, and can be seen in cases of dementia (due to Alzheimer's, or, sometimes, numerous strokes in which case it is called multi-infarct dementia). Thank you for this interesting question, and again we apologize for not answering sooner. | |
