Bálint syndrome caused by bilateral medial occipital infarcts

Excerpt

A 78-year-old woman known for treated hypertension presented a 3-day history of spatial disorientation, attention deficit, word-finding difficulties, and diffuse visual impairment. Examination showed mild anomic aphasia, verbal anterograde amnesia, partial right homonymous hemianopsia (with preservation of the right inferior quadrant for the right eye), and Bálint syndrome. This consisted of optic ataxia for both hands in her preserved visual field, ocular apraxia with difficulties to shift gaze to targets in her intact visual field, visual simultagnosia with inability to detect more than one out of two or more points simultaneously presented to her visual field during a few seconds. However, she was able to describe single parts of pictures and letters of a word. Additional visual phenomena were palinopsia and “vanishing” objects perception, i.e., the persistence of visual stimuli perception after they left the visual field and, conversely, the sudden perceptive loss of an object which yet remained in the visual field. Brain MRI showed acute ischemic lesions in the left posterior cerebral artery territory, including medial temporal and occipital lobes, but no parietal lesion. In addition, it revealed a previously unknown chronic right medial occipital lobe infarct and diffuse leukoaraiosis (Fig. 1).

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