Balint's syndrome
| Balint's syndrome | |
|---|---|
| Classification and external resources | |
| ICD-9 | 368.16 |
Balint's syndrome, identified by the Austro-Hungarian neurologist Rezső Bálint in 1909,[1][2] is a disjointed psychic paralysis of gaze with haphazard scanning. It is characterized by optic ataxia (incoordination of hand and eye movement), oculomotor apraxia (the inability to voluntarily guide eye movements/ change to a new location of visual fixation), and simultanagnosia (the inability to perceive more than one object at a time, even when in the same place).
Neuroanatomical evidence
Balint's syndrome has been found in patients with bilateral damage to the posterior parietal cortex. The primary cause of the damage and the syndrome can originate from multiple strokes, Alzheimer's disease, intracranial tumors, or brain injury. Multifocal leukoencephalopathy and Creutzfeldt-Jakob disease have also been found to cause this kind of damage. This syndrome is caused by damage to the posterior superior watershed areas, also known as the parietal-occipital vascular border zone (Brodmann's areas 19 and 7). Balint's syndrome has only recently been reported in children.[3] In children this syndrome results in a variety of occupational difficulties, but most notably difficulties in schoolwork, especially reading.
Case Studies
Symptoms of Balint’s syndrome were found in the case of a 29 year old migraine sufferer. In the aura before the migraine headache, she experienced an inability to see all of the objects in the visual field simultaneously; an inability to coordinate hand and eye movements; and an inability to look at an object on command[4]. Symptoms were not present before the onset of the migraine or after it passed. A study of a patient with Corticobasal Ganglionic Degeneration (CGBD) also showed a development of Balint’s syndrome. As a result of CGBD, the patient developed an inability to move his eyes to specific visual objects in his peripheral fields. He also was unable to reach out and touch objects in his peripheral fields. An inability to recognize more than one item at a time was also experienced when presented with the Cookie Theft Picture[5] from the Boston Diagnostic Aphasia Examination. A patient with congenital deafness exhibited partial Balint’s syndrome symptoms. This patient experienced an inability to perceive simultaneous events in her visual field. She was also unable to fixate and follow an object with her eyes. In addition, her ability to point at targets under visual guidance was impaired[6].
Treatment
Treatment for Balint's syndrome usually takes advantage of an adaptive functional approach, where the individual's strengths are utilized in order to address his or her difficulties. Two additional treatments of Balint’s syndrome have also been developed. The remedial approach aims to restore the damaged CNS by training in perceptual skills. Tabletop activities and sensorimotor tasks are suggested for this approach. The intended outcome of this approach is to generalize skills to everyday living. The next approach is called the multicontext approach. This approach involves practicing a targeted strategy in an environment with varied tasks and movement demands. It also incorporates self awareness tasks[7] .
References
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hu: Bálint-szindróma- ↑ synd/1343 at Who Named It?
- ↑ R. Balint. Seelenlähmung des "Schauens", optische Ataxia, räumliche Störung der Aufmerksamkeit. Monatsschrift für Psychiatrie und Neurologie, 1909, 25: 51-81.
- ↑ Gillen, J.A. and Dutton, G.N. (2003). Balint's syndrome in a 10-year-old male. Developmental Medicine & Child Neurology, 45:349-32.
- ↑ Shah, P. & Nafee, A. (1999) Migraine aura masquerading as Balint’s syndrome. Journal of Neurology, Neurosurgery and Psychiatry 67:554-555. Found at http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1736566&blobtype=pdf
- ↑ Mendez, Mario F., M.D., Ph.D. (2000). Corticobasal Ganglionic Degeneration With Balint’s Syndrome. The Journal of Neuropsychiatry & Clinical Neuroscience. Found at http://neuro.psychiatryonline.org/cgi/content/full/12/2/273
- ↑ Drane, DL, Lee, GP, Huthwaite, JS, Tirschwell, DL, Baudin, BC, Juado, M, Ghodke, B, Marchman, HB. (2008) Development of a Partial Balint’s Syndrome in a Congenitally Deaf Patient Presenting as Pseudo-Aphasia. The Clinical Neuropsychologist. Found at http://www.unboundmedicine.com/medline/ebm/record/18923965/abstract/Development_of_a_Partial_Balint's_Syndrome_in_a_Congenitally_Deaf_Patient_Presenting_as_Pseudo_Aphasia_
- ↑ Al-Khawaja. (2001) Neurovisual rehabilitation in Balint’s syndrome. Journal of Neurology, Neurosurgery and Psychiatry. Found at http://www.accessmylibrary.com/coms2/summary_0286-10338409_ITM
