Acute onset lateropulsion strongly suggests a medullary infarction

Abstract

Body lateropulsion is the compelling sensation of being pulled toward one side. We report five cases presenting body lateropulsion as a chief complaint. All of them were admitted to our hospital with an ataxia of unknown origin. Some cases were accompanied with Horner’s syndrome (2/5), sensory loss in face or lower limbs (2/5), and limb ataxia (1/5). Corresponding lesion of the lateropulsion appeared on MRI 2 to 11 days after onset. The ipsilateral ventral spinocerebellar tract causes body lateropulsion. The contralateral ascending graviceptive pathway may also cause body lateropulsion. In cases presenting acute onset lateropulsion, we should perform a detailed neurological examination to not overlook the signs accompanied by Wallenberg syndrome and keep a possibility of medullary infarction in mind even if we cannot detect the lesion on early diffusion weighted MRI.