Balint's syndrome in subacute HIV encephalitis

Abstract

A 45 year old patient with AIDS is described in whom Balint's syndrome developed over several days without other higher cognitive defects. Radiological findings were typical of subacute HIV encephalitis involving mainly the white matter of the occipital lobes with extension into the parietal and temporal lobe on the left side and into the temporal lobe on the right side. While the patient could usually recognise only one single component within her visual field, her performance in reading much improved if she was allowed to observe the examiner writing. This finding is attributed to well preserved movement perception in our patient, which may have helped her in directing her visual attention. The preservation of movement perception despite damage to the lateral temporo-occipital area may be due to the distinct pathology of subacute HIV encephalitis, which leaves the cortex and adjacent subcortical white matter virtually intact and therefore allows information transfer between primary visual areas in the occipital lobe and movement specific areas in the lateral temporo-occipital area through U-fibres.