Hospital Universitario "Dr. José E. González", Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, México.
Rev Neurol. 2023 Jan 16;76(2):69-73. doi: 10.33588/rn.7602.2021349.
Gait disorders are commonly overlooked as a presenting manifestation of stroke and underrepresented in case series. We describe four cases of sudden-onset gait lateropulsion as primary manifestation of parietal lobe stroke.
Four patients presented after sudden-onset gait lateropulsion. On neurological examination, all patients had at least one cortical sensory deficit and wide-based gait with lateropulsion towards the side of the cortical deficit. Neuroimaging revealed a subacute parietal lobe stroke contralateral to the side of gait lateropulsion. In two patients we found bilateral lateropulsion with predominance towards the side of cortical deficit and increase of unsteadiness with eye closure (an apparent Romberg sign), with neuroimaging revealing bilateral parietal strokes (subacute contralateral and chronic ipsilateral to gait lateropulsion).
We report gait lateropulsion as a novel primary manifestation of acute stroke of the parietal lobe (parietal gait lateropulsion). Given its role as the destination of proprioceptive pathways, parietal strokes can result in gait lateropulsion, with bilateral lesions even mimicking sensory ataxia with bilateral lateropulsion and unsteadiness upon eye closure.
步态障碍通常被忽视为中风的表现形式，在病例系列中代表性不足。我们描述了 4 例以突发性侧方步态偏倚为顶叶中风主要表现的病例。
4 例患者出现突发性步态侧方偏倚。在神经学检查中，所有患者均至少存在一处皮质感觉缺失和宽基底步态，并伴有向皮质缺失侧的侧方偏倚。神经影像学显示与步态侧方偏倚侧相对应的亚急性顶叶中风。在 2 例患者中，我们发现双侧侧方偏倚，以皮质缺失侧为主，并伴有闭眼时不稳定性增加（明显的 Romberg 征），神经影像学显示双侧顶叶中风（亚急性对侧和慢性同侧与步态侧方偏倚）。
我们报告了一种新的急性顶叶中风（顶叶步态侧方偏倚）的主要表现形式，即步态侧方偏倚。鉴于其作为本体感觉通路的目的地，顶叶中风可导致步态侧方偏倚，双侧病变甚至可模拟双侧侧方偏倚和闭眼时不稳定性的感觉性共济失调。
