Pusher syndrome

Pusher syndrome is a neurological condition observed in some patients following a stroke or other brain injury that has caused hemiparesis, in which the patient actively pushes away from the unweakened side, leading to loss of postural balance推挤综合征是一种在部分中风或其他脑损伤导致偏瘫的患者中观察到的神经学病症，患者主动从非虚弱侧推离，导致姿势平衡丧失。

The condition is found in approximately 10.4 per cent of patients with acute stroke and hemiparesis, and affected patients may take longer to recover than those without pushing behaviour该病症存在于约10.4%的急性中风和偏瘫患者中，受影响的患者可能比没有推挤行为的患者康复时间更长。

The lesion involved is thought to be in the posterior thalamus or in multiple areas of the right brain hemisphere, and the condition can be a result of either left or right brain damage据认为涉及的病灶位于后丘脑或右脑半球的多个区域，该病症可以是左脑或右脑损伤的结果。

Terminology and classification

• Pusher syndrome was first systematically described in the late 1980s by Danish researchers studying postural control in stroke patients推挤综合征在1980年代末由研究中风患者姿势控制的丹麦研究人员首次系统描述。^[1]
• The condition is also known as lateropulsion or pushing syndrome, and is classified under post-stroke motor complications in neurological taxonomies该病症也称为侧冲或推挤综合征，在神经学分类中归类于中风后运动并发症。^[1]
• Wikidata maps Pusher syndrome to Q2119091 with MedlinePlus Q83042 as a related resource, but the condition lacks a specific ICD-10 or ICD-11 codeWikidata 将推挤综合征映射到 Q2119091，MedlinePlus Q83042 作为相关资源，但该病症缺乏特定的 ICD-10 或 ICD-11 编码。^[2]
• The condition is distinguished from hemispatial neglect, although both can coexist in patients with right hemisphere stroke推挤综合征与半侧空间忽略不同，尽管两者可同时存在于右半球中风患者中。^[1]
• Pusher syndrome is classified as a postural control disorder rather than a motor strength deficit, as the affected limb may have preserved strength推挤综合征归类为姿势控制障碍而非肌力缺陷，因为受累肢体可能保持肌力。^[1]
• The condition is related to the broader concept of postural control dysfunction and is studied within the framework of stroke rehabilitation该病症与姿势控制功能障碍的更广泛概念相关，在中风康复框架内进行研究。^[1]

History

• The syndrome was first systematically described in the late 1980s by Danish researchers studying postural control in stroke patients该综合征在1980年代末由研究中风患者姿势控制的丹麦研究人员首次系统描述。^[1]
• The term pusher syndrome was coined to describe the paradoxical behaviour of patients who preferentially bear weight on the weak side推挤综合征这一术语被创造出来，以描述患者倾向于在虚弱侧承重的矛盾行为。^[1]
• The Copenhagen Stroke Study established that patients with pushing behaviour had significantly longer recovery times, taking 3.6 weeks longer on the Barthel Index哥本哈根中风研究确立了具有推挤行为的患者康复时间显著更长，巴塞尔指数多花3.6周。^[1]
• In 2003, Karnath and colleagues proposed that the lesion involves the posterior thalamus or its connecting pathways to the cortex2003年，Karnath 等提出病灶涉及后丘脑或其与皮质的连接通路。^[3]
• Further studies identified right hemisphere structures including the posterior insula and temporoparietal junction as additional lesion sites进一步研究确定右半球结构（包括后岛叶和颞顶交界处）为额外病灶部位。^[3]
• The Scale for Contralateral Pusher Behaviour (SCP) was developed in 2008 to provide standardized tools for quantifying severity2008年开发了对侧推挤行为量表（SCP），为量化严重程度提供标准化工具。^[1]

Epidemiology

• Pusher syndrome occurs in approximately 10.4 per cent of patients with acute stroke and hemiparesis推挤综合征存在于约10.4%的急性中风和偏瘫患者中。^[1]
• The syndrome can occur after either left or right hemisphere stroke, though some studies suggest higher prevalence after right hemisphere lesions该综合征可发生在左半球或右半球中风后，尽管一些研究提示右半球病灶后患病率较高。^[1]
• Patients with pusher syndrome demonstrate significantly longer hospital stays and slower functional recovery推挤综合征患者的住院时间显著更长，功能恢复更慢。^[1]
• The severity of pushing behaviour varies from mild to severe and can fluctuate during recovery推挤行为的严重程度从轻度到重度不等，在康复期间可波动。^[1]
• No clear gender or age predilection has been consistently reported文献中尚未一致报告明确的性别或年龄偏好。^[1]

Pathophysiology

• The lesion involves the posterior thalamus, particularly the pulvinar and its connections to the postcentral cortex病灶涉及后丘脑，特别是 pulvinar 及其与中央后皮质的连接。^[3]
• Right hemisphere structures including the posterior insula, temporoparietal junction and superior temporal gyrus have also been implicated右半球结构（包括后岛叶、颞顶交界处和颞上回）也已被涉及。^[3]
• The disorder arises from disruption in the sensory weighting system, where the brain misinterprets proprioceptive and visual information该病症源于感觉权重系统的破坏，大脑错误解读本体感觉和视觉信息。^[3]
• Posturography studies show increased postural sway towards the affected side and reduced ability to shift weight to the intact side姿势描记法研究显示向受累侧方向的姿势摇摆增加，向完整侧转移重心的能力降低。^[1]
• Pusher syndrome is not associated with muscle weakness or spasticity推挤综合征与肌无力或痉挛无关。^[1]

Clinical features

• The hallmark is active pushing of the body away from the unweakened side, causing the patient to lean towards the affected side标志是主动将身体从非虚弱侧推离，导致患者向受累侧倾斜。^[1]
• Patients resist any attempt to correct their posture, actively pushing back towards the affected side患者抗拒纠正姿势的任何尝试，主动向受累侧推回。^[1]
• The pushing behaviour is most prominent during sitting and standing but can also be observed during walking推挤行为在坐着和站立时最为明显，但在行走时也可观察到。^[1]
• The condition is accompanied by loss of postural balance and increased risk of falls该病症伴有姿势平衡丧失和跌倒风险增加。^[1]
• Pusher syndrome can coexist with hemispatial neglect, aphasia and sensory loss推挤综合征可与半侧空间忽略、失语和感觉丧失共存。^[1]

Diagnosis

• Diagnosis is based on clinical observation of characteristic pushing behaviour during postural tasks诊断基于对姿势任务期间特征性推挤行为的临床观察。^[1]
• The Scale for Contralateral Pusher Behaviour (SCP) quantifies severity across sitting, standing and walking对侧推挤行为量表（SCP）量化坐着、站立和行走时的严重程度。^[1]
• Brain imaging including CT and MRI identifies the underlying lesion in posterior thalamus or right hemisphere包括 CT 和 MRI 在内的脑影像学识别后丘脑或右半球的潜在病灶。^[3]
• The differential diagnosis includes hemispatial neglect and vestibular disorders鉴别诊断包括半侧空间忽略和前庭疾病。^[1]

Management

• Rehabilitation is the primary treatment, focusing on weight-shifting training towards the intact side康复是主要治疗，侧重于向完整侧转移重心的训练。^[1]
• Physical therapy includes trunk rotation exercises, weight-shifting and haptic feedback物理治疗包括躯干旋转练习、重心转移和触觉反馈。^[1]
• Occupational therapy addresses functional tasks requiring postural adjustments作业治疗针对需要姿势调整的功能任务。^[1]
• Fall prevention strategies and assistive devices reduce injury risk跌倒预防策略和辅助设备降低受伤风险。^[1]
• Early identification and targeted rehabilitation can reduce recovery time早期识别和针对性康复可以减少恢复时间。^[1]

Research and controversies

• The exact neural mechanism remains debated with different studies implicating different brain regions确切神经机制仍存在争议，不同研究涉及不同脑区。^[3]
• Whether pusher syndrome should be classified as a distinct entity is controversial关于推挤综合征是否应归类为独立实体存在争议。^[1]
• The effectiveness of specific rehabilitation approaches is still being studied特定康复方法的有效性仍在研究中。^[1]
• The relationship with other post-stroke perceptual disorders is an area of active research与其他中风后感知障碍的关系是活跃的研究领域。^[3]

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