Balint syndrome (chronic visual-spatial disorder) presenting without known cause

Abstract

Balint's syndrome is a rare disorder characterized by a triad of simultanagnosia, optic apraxia, and ocular apraxia. The syndrome manifests when there is an injury to the posterior parietal and occipital lobes and is often bilateral. Several causes of this syndrome were published in the literature, such as trauma, infarctions, infections, tumors, and pre-eclampsia. It can also be the presenting feature of several neurodegenerative disorders, such as atypical Alzheimer's disease. We report a case of a 62-year-old lady who presented with simultanagnosia, optic apraxia, and ocular ataxia which are the typical signs and symptoms of this syndrome. Neuropsychological evaluation revealed severe affection of the visual-spatial function with intact memory, language, and cognition. Brain imaging confirmed atrophy and decreased perfusion in the posterior parietal and occipital lobes. No underlying cause could be identified to explain the brain parenchymal atrophy. The follow-up neuropsychological assessment and brain imaging did not show any progression confirming the static course of the disease.

Keywords: Balint's syndrome; Optic apraxia; Parieto-occipital atrophy; Simultanagnosia; Visual-spatial disorder.

Fig. 1

Axial T2 and sagittal T1-weighted MRI showing moderate bilateral occipital lobes and posterior parietal lobes atrophy (white arrows) with preserved temporal and frontal lobes volume (black arrows)

Fig. 2

Nuclear medicine SPECT perfusion scan showing severely reduced perfusion involving bilateral occipital and posterior parietal lobes with normal perfusion of the frontal and temporal lobes.