Clinical Image

Balint's Syndrome Secondary to Cortico-Basal Degeneration

Ahmad A Al-Awwad1*, Tuan A Pham1, Anil Patel2 and Linda A Hershey1
1Department of Neurology, University of Oklahoma Health Sciences Center, USA
2Dean McGee Eye Institute, Oklahoma, USA


*Corresponding author: Ahmad A Al-Awwad, Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, 920 Stanton L. Young Blvd, Suite 2040, OK 73104-5036, USA


Published: 20 Sep, 2017
Cite this article as: Al-Awwad AA, Pham TA, Patel A, Hershey LA. Balint's Syndrome Secondary to Cortico-Basal Degeneration. J Neurosci Cogn Stud. 2017; 1(1): 1004.

Keywords

Balint’s syndrome; Cortico-basal degeneration; Parieto-occipital junction


Clinical Image

A 70-year-old man with Cortico-Basal Degeneration (CBD) diagnosed 7 years ago presented to the neurology clinic complaining of 2 year worsening visual agnosia. Physical exam showed severe cognitive impairment (MMSE of 7/30), severe motor apraxia on rapid alternating movements, rigidity in both arms, and body bradykinesia. He walked slowly with small, shuffling steps. Neuroophthalmolgy exam revealed the classic triad of Balint’s syndrome including simultanagnosia (inability of to perceive more than one object at a time), oculomotor apraxia (impaired visual scanning and difficulty in fixating the eyes despite normal eye movement), and optic ataxia (inability to move the hand to a specific object by using vision) [1,2]. PET scan showed hypometabolism in both parietal lobes which is commonly seen in CBD and brain MRI revealed atrophy in the parietooccipital junction (Figure 1). On the basis of these findings, patient was diagnosed with Balint’s syndrome as the result of the progressive of CBD.


Figure 1

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Figure 1
MRI shows atrophy in the parieto-occipital junction bilaterally: (A) Axial T2 FLAIR. (B) Coronal T1 FSE. (C) Sagittal T1 FSE (Left hemisphere). (D) Sagittal T1 FSE (Right hemisphere).

References

  1. Bálint R. Soul imbalance of "seeing", optical ataxia, spatial disturbance of attention. Mschr Psychiat Neurol. 1909;25:51-81.
  2. Tang-Wai DF, Josephs KA, Boeve BF, Dickson DW, Parisi JE, Petersen RC. Pathologically confirmed corticobasal degeneration presenting with visuospatial dysfunction. Neurology. 2003;61(8):1134-5.