Case 11 · clinician
Stroke patient who resists being made upright
Vignette
A 72-year-old man is 5 days into rehabilitation after a right hemispheric ischaemic stroke. He has a left hemiparesis and left hemispatial neglect. When seated, his trunk lists 15° to the left, and he pushes hard against the therapist's attempts to correct it, insisting he is upright. Bedside bucket SVV (visual vertical) is +0.5°. When passively tilted in a chair with eyes closed and asked to indicate when he is upright, he consistently calls upright at a position 13° tilted to the left.
SVV trace
Visual SVV near-normal; postural vertical grossly tilted