Platform Presentation The Joint Annual Meeting of the Stroke Society of Australasia (SSA) and Smartstrokes 2023

Post-stroke Lateropulsion: Pushing for Greater Understanding of the Role of Lesion Location (#52)

Jessica Nolan 1 2 3 , Michael Bynevelt 4 , Ferry Dharsano 4 , Erin Godecke 2 5 6 , Angela Jacques 7 8 , Barby Singer 2
  1. The University of Notre Dame Australia, Fremantle, WA, Australia
  2. School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
  3. Physiotherapy, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, WA, Australia
  4. Neurological Intervention and Imaging Service Western Australia, Nedlands, WA, Australia
  5. Allied Health Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, WA, Australia
  6. Centre of Research Excellence in Aphasia Recovery and Rehabilitation, La Trobe University, Melbourne, Vic, Australia
  7. Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
  8. Research, Sir Charles Gairdner Osborne Park Health Care Group, Nedlands, WA, Australia

Background: Post-stroke lateropulsion is prevalent and associated with poor rehabilitation outcomes, independent of stroke severity. Prior smaller studies have shown associations between lateropulsion presence and a variety of stroke lesion locations.

 

Aims: This study aimed to investigate the association between neuroimaging data and the presence of lateropulsion on admission to inpatient rehabilitation.

 

Methods: This prospective study conformed to the STROBE statement for observational studies and included participants aged ≥65 years admitted for inpatient stroke rehabilitation. Stroke lesion location and size were reported by a neuroradiologist, with findings verified by a second neuroradiologist. Lateropulsion presence (Four Point Pusher Score – 4PPS) was assessed at rehabilitation admission.

 

Results: Of 144 included participants, 82 (56.9%) had lateropulsion (4PPS≥1) on admission. Lateropulsion presence was univariately associated with haemorrhagic stroke (p=0.002), frontal cortical involvement (OR=2.17, 95%CI 1.02-6.46) and white matter involvement (OR=2.45, 95%CI 1.24-4.85), particularly frontal white matter (p=0.021). Associations between lateropulsion presence and lesions in the internal capsule (OR=2.16, 95%CI 0.99-4.70) and thalamus (OR=2.16, 95%CI 0.99-4.70) approached significance. When stratified by stroke type, no specific location was significantly associated with lateropulsion presence in haemorrhagic strokes. Among participants with ischaemic stroke, frontal cortical involvement (OR=3.67, 95%CI 1.61-8.37), particularly pre-central gyrus (OR=2.45, 95%CI 1.05-5.76) and parietal cortical involvement (OR=2.54, 95%CI 1.15-5.61), particularly post-central gyrus (OR=2.76, 95%CI 1.15-6.60), inferior parietal cortex (OR=3.95, 95%CI 1.43-10.90) and supramarginal gyrus (OR=3.73, 95%CI 1.25-11.13) were associated with lateropulsion presence. White matter involvement (OR=2.22, 95%CI 1.04-4.74) was associated with lateropulsion presence in ischaemic strokes, but no specific area of white matter involvement significantly predicted lateropulsion presence. Side of stroke and lesion volume were not significantly associated with lateropulsion presence.

 

Conclusion: While haemorrhagic stroke was associated with lateropulsion presence, lateropulsion was associated with specific cortical and sub-cortical areas only in ischaemic strokes. Future lesion-network mapping studies including greater numbers of participants are recommended.