Balint Syndrome

1. Ade Wijaya, MD – March 2020

2.  Rudolf Balint first described Balint syndrome in 1909
Ocular Apraxia
SimultagnosiaOptic Ataxia
Moreaud O. Balint syndrome. Arch. Neurol. 2003 Sep;60(9):1329-31.

3.  Ischemic infarctions in bilateral parietal and occipital areas.
 Posterior reversible encephalopathy syndrome (PRES)
 Alzheimer disease
 Creutzfeldt-Jakob disease (CJD)
 Posterior cortical atrophy (PCA)
 Corticobasal degeneration (CBD)
 Subacute HIV encephalitis
 Progressive multifocal leukoencephalopathy (PML)
 Head trauma
 Cerebral toxoplasmosis, and
 Brain metastasis
 Anti-NMDA receptor encephalitis
 Idiopathic
Kumar S, Abhayambika A, Sundaram AN, Sharpe JA. Posterior reversible encephalopathy syndrome presenting as Balint syndrome. J Neuroophthalmol. 2011 Sep;31(3):224-7.
Metzger A, Pisella L, Vighetto A, Joubert B, Honnorat J, Tilikete C, Desestret V. Balint syndrome in anti-NMDA receptor encephalitis. Neurol Neuroimmunol Neuroinflamm. 2019
Jan;6(1):e532.
Ghoneim A, Pollard C, Greene J, Jampana R. Balint syndrome (chronic visual-spatial disorder) presenting without known cause. Radiol Case Rep. 2018 Dec;13(6):1242-1245.

4.  Lack of coordination between visual input and hand
movements
 Difficulty in reaching out to visually guided objects
Amalnath SD, Kumar S, Deepanjali S, Dutta TK. Balint syndrome. Ann Indian Acad Neurol. 2014 Jan;17(1):10-1.
Rizzo M, Vecera SP. Psychoanatomical substrates of Bálint's syndrome. J. Neurol. Neurosurg. Psychiatry. 2002 Feb;72(2):162-78.

5.  Inability to voluntarily shift gaze despite the intact
function of extraocular muscles
Chechlacz M, Humphreys GW. The enigma of Bálint's syndrome: neural substrates and cognitive deficits. Front Hum Neurosci. 2014;8:123.

6.  The lack of ability to perceive more than a single object
at a time
Dorsal:
The lesion is postulated to be in the bilateral parietal lobes
The patient is often unable to see more than one object at a time
Ventral:
The lesion is postulated to be in the left inferior occipitotemporal lobe
The patient has slower visual processing speed and is unable to identify
individual parts of a multi-part object
Battaglia-Mayer A, Caminiti R. Optic ataxia as a result of the breakdown of the global tuning fields of parietal neurones. Brain. 2002 Feb;125(Pt 2):225-37.

7. Computed tomogram (CT)
scan and magnetic
resonance imaging
(MRI) of the brain
usually reveal atrophic
changes in parietal and
occipital lobes
Ghoneim A, Pollard C, Greene J, Jampana R. Balint syndrome (chronic visual-spatial
disorder) presenting without known cause. Radiol Case Rep. 2018 Dec;13(6):1242-1245.

8.  Based in etiology
 Rehabilitation (Occupational)
 Prognosis depend on the etiology
Al-Khawaja I, Haboubi NH. Neurovisual rehabilitation in Balint's syndrome. J. Neurol. Neurosurg. Psychiatry. 2001 Mar;70(3):416.