Isolated Body Lateropulsion: A Rare Clinical Presentation of Midbrain Infarction

Lateropulsion, a tendency of the body to lean or fall to one side without weakness or limb ataxia, is most often associated with lateral medullary infarction but may also occur with pontine, cerebellar, thalamic, or midbrain lesions. Isolated body lateropulsion due to midbrain infarction, however, is rare. We report an 86-year-old woman who developed acute lateropulsion without ocular, sensory, or motor deficits. Diffusion-weighted MRI showed a small infarct in the right rostral paramedian midbrain, medial to the red nucleus. Her symptoms improved with rehabilitation. The lesion location suggests selective disruption of the vestibulo-thalamic pathway, highlighting its role in postural control and its vulnerability to a small lesion. Recognizing this presentation facilitates accurate lesion localization in midbrain infarction.