Some patients with a stroke present with a disturbance in upright posture.

Features of the pusher syndrome:

(1) The patient uses the non-paretic arm and/or leg to actively push towards the paralyzed side.

(2) The patient stands with a tilt 20 degrees or more towards the paralyzed side.

(3) The patient has a severe misperception of his/her own upright body orientation and perceives that s/he is standing vertical.

(4) The patient resists any attempt to be passively moved into the true vertical.

(5) Visual-vestibular processing is almost intact.


The syndrome is associated with loss of balance and falls towards the paralyzed side.


The infarct tends:

(1) to involve the insular cortex and parts of the postcentral gyrus

(2) to spare the thalamus

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