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To the Editor:
We read with interest the article by Karnath et al.1 describing the thalamic localization of the “pusher syndrome.” Their careful study of the disturbed perception of the orientation in space experienced by these patients may partially explain their loss of stability
Postural instability with thalamic lesions (thalamic astasia) was present in 15 patients we described.2 We selected our patients differently, paying attention to the presence of instability and the lack of sufficient weakness to explain it. However, the localization of the lesions reported by Karnath et al. as causing the pusher syndrome coincides remarkably with the localization of the lesions in our patients. In both cases the postero-lateral portion of the thalamus and the suprathalamic white matter were maximally involved. Our patients also tended to fall to the affected side of the body
Although Karnath et al. focus on the contraversive behavior, they also mention a lack of stability in their patients. In five of them pushing behavior while standing could …
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