Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-669899f699-swprf Total loading time: 0 Render date: 2025-04-30T18:59:33.301Z Has data issue: false hasContentIssue false

15 - Bálint's syndrome

Published online by Cambridge University Press:  10 October 2009

By
Alain Vighetto  and
Pierre Krolak-Salmon
Edited by
Olivier Godefroy  and
Julien Bogousslavsky
Alain Vighetto
Affiliation:
Hôpital neurologique Pierre Wertheimer, Lyon and Université Claude Bernard Lyon I
Pierre Krolak-Salmon
Affiliation:
Hôpital neurologique Pierre Wertheimer, Lyon and Université Claude Bernard Lyon I
Olivier Godefroy
Affiliation:
Université de Picardie Jules Verne, Amiens
Julien Bogousslavsky
Affiliation:
Université de Lausanne, Switzerland
Get access

Summary

Introduction

Bálint's syndrome is a clinical entity which combines variously a set of complex spatial behavior disorders following bilateral damage to the occipital–parietal junction. The core syndrome is a triad, namely optic ataxia, gaze apraxia, and simultanagosia, to which visual–spatial perception deficits can be associated. Both diversity of terminology used in literature and bias in clinical descriptions, which often reflect a particular opinion of the authors on underlying mechanisms, add to the difficulty in describing and comprehending this rare and devastating syndrome. As the components are not elementary symptoms, and as they are not necessarily present in each case, indicating they do not rely upon a single brain mechanism, validity of the complex as a syndrome has been questioned (Rizzo and Vecera, 2002). Despite these flaws, Bálint's syndrome can be identified at the bedside examination and it allows robust anticipation of lesion localization.

Historically, Bálint provided in 1909 a thorough clinical and postmortem description of a patient who exhibited hitherto undescribed symptoms, he named Seelenlähmung des “Schauens,” optische Ataxie, raümliche Störung der Aufmerksamkeit, usually translated as psychic paralysis of gaze, optic ataxia, and spatial disorder of attention. He related these symptoms to a bilateral area of ischemic suffering in the posterior parietal and anterior occipital regions, including the angular gyrus and underlying white matter on both sides. In Bálint's view, psychic paralysis of gaze was a consequence of attention impairment and not of eye movement disorder per se; meanwhile optic ataxia was explained in terms of disconnection between visual and motor centers.

Type
Chapter
Information
The Behavioral and Cognitive Neurology of Stroke , pp. 294 - 314
Publisher: Cambridge University Press
Print publication year: 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

Al-Khawaja, I. and Haboubi, N. H. (2001). Neurovisual rehabilitation in Balint's syndrome. J. Neurol. Neurosurg. Psychiatry, 70(3), 416.CrossRefGoogle ScholarPubMed
Allison, R. S., Hurwitz, L. J., et al. (1969). A follow-up study of a patient with Balint's syndrome. Neuropsychologia, 7, 319–33.CrossRefGoogle Scholar
Andersen, R. A. (1997). Multimodal integration for the representation of space in the posterior parietal cortex. Phil. Trans. R. Soc. Lond., 352, 1421–8.CrossRefGoogle ScholarPubMed
Astafiev, S. Y., Shulman, G. I., et al. (2003). Functional organisation of human parietal and frontal cortex for attending, looking and pointing. J. Neurosci., 23, 4689–99.CrossRefGoogle ScholarPubMed
Auerbach, S. H. and Alexander, M. P. (1981). Pure agraphia and unilateral optic ataxia associated with a left superior parietal lobule lesion. J. Neurol. Neurosurg. Psychiatry, 44(5), 430–2.CrossRefGoogle ScholarPubMed
Badal, J. (1888). Contribution à l'étude des cécités psychiques: Alexie, agraphie, hémianopsie inférieure, trouble du sens de l'espace. Arch. Ophthalmol., 140, 97–117.Google Scholar
Bálint, R. (1909). Seelenlähmung des Schauens, optische Ataxie, raümliche Störung der Aufmerksamkeit. Monatsschrift für Psychiatrie und Neurologie, 25, 51–81.CrossRefGoogle Scholar
Battaglia-Mayer, A., Caminiti, R., et al. (2003). Multiple levels of representation of reaching in the parieto-frontal network. Cereb. Cortex, 13, 1009–22.CrossRefGoogle ScholarPubMed
Battaglia-Mayer, A., Ferraina, S., et al. (2000). Early coding of reaching in the parietooccipital cortex. J. Neurophysiol., 83, 2374–91.CrossRefGoogle ScholarPubMed
Bellebaum, C., Hoffmann, K. P., and Daum, I. (2005). Post-saccadic updating of visual space in the posterior parietal cortex in humans. Behav. Brain Res., 163, 194–203.CrossRefGoogle ScholarPubMed
Binkofski, F., Buccino, G., et al. (1999). Mirror agnosia and mirror ataxia constitute different parietal lobe disorders. Ann. Neurol., 46, 51–61.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
Binkofski, F., Dohle, C., et al. (1998). Human anterior intraparietal area subserves prehension: a combined lesion and functional MRI activation study. Neurology, 50(5), 1253–9.CrossRefGoogle ScholarPubMed
Brain, R. (1941). Visual discrimination with special reference to lesions of the right hemisphere. Brain, 64, 244–72.CrossRefGoogle Scholar
Carey, D. P., Coleman, R. J., et al. (1997). Magnetic misreaching. Cortex, 33(4), 639–52.CrossRefGoogle ScholarPubMed
Castaigne, P., Rondot, P., et al. (1975). Ataxie optique localisée au côté gauche des deux hémichamps visuels homonymes. Rev. Neurol. (Paris), 131(1), 23–8.Google Scholar
Classen, J., Kunesch, E., et al. (1995). Subcortical origin of visuomotor apraxia. Brain, 118, 1365–74.CrossRefGoogle ScholarPubMed
Cogan, D. G. and Adams, R. D. (1953). A type of paralysis of conjugate gaze (ocular motor apraxia). Arch. Ophthalmol., 50(4), 434–42.CrossRefGoogle Scholar
Colby, C. L. and Goldberg, M. E. (1999). Space and attention in parietal cortex. Ann. Rev. Neurosci., 22, 319–49.CrossRefGoogle ScholarPubMed
Crawford, J. D., Medendorp, W. P., et al. (2004). Spatial transformations for eye-hand coordination. J. Neurophysiol., 92, 10–19.CrossRefGoogle ScholarPubMed
Damasio, A. R. and Benton, A. L. (1979). Impairment of hand movements under visual guidance. Neurology, 29, 170–4.CrossRefGoogle ScholarPubMed
Renzi, E. (1989). Balint-Holmes syndrome. In Classic Cases in Neuropsychology. Hove: Psychology Press, pp.123–43.Google Scholar
Duhamel, J. R., Colby, C. L., et al. (1992). The updating of the representation of visual space in parietal cortex by intended eye movements. Science, 255 (5040), 90–2.CrossRefGoogle ScholarPubMed
Ferro, J. M. (1984). Transient inaccuracy in reaching caused by a posterior parietal lobe lesion. J. Neurol. Neurosurg. Psychiatry, 47(9), 1016–19.CrossRefGoogle ScholarPubMed
Friedman-Hill, S. R., Robertson, L. C., et al. (1995). Parietal contributions to visual feature binding: Evidence from a patient with bilateral lesions. Science, 269(5225), 853–5.CrossRefGoogle ScholarPubMed
Galletti, C., Kutz, D. F., et al. (2003). Role of the medial parieto-occipital cortex in the control of reaching and grasping movements. Exp. Brain Res., 153(2), 158–70. Epub 2003 Sep 27.CrossRefGoogle ScholarPubMed
Garcin, R., Rondot, P., et al. (1967). Ataxie optique localisée aux deux hémichamps visuels homonymes gauches. Rev. Neurol. (Paris), 116(6), 707–14.Google Scholar
Girotti, F., Milanese, C., et al. (1982). Oculomotor disturbances in Balint's syndrome: Anatomoclinical findings and electrooculographic analysis in a case. Cortex, 18(4), 603–14.CrossRefGoogle ScholarPubMed
Goodale, M. A. and Milner, A. D. (1992). Separate visual pathways for perception and action. Trends Neurosci., 15, 20–5.CrossRefGoogle ScholarPubMed
Gottlieb, D., Calvanio, R., et al. (1991). Reappearance of the visual percept after intentional blinking in a patient with Balint's syndrome. J. Clin. Neuroophthalmol., 11(1), 62–5.Google Scholar
Guard, O., Perenin, M. T., et al. (1984). Syndrome pariétal bilatéral ressemblant au syndrome de Balint. Rev. Neurol., 140(5), 358–67.Google Scholar
Hecaen, H. and Ajuriaguerra, J. (1954). Balint's syndrome (psychic paralysis of visual fixation) and its minor forms. Brain, 77(3), 373–400.CrossRefGoogle ScholarPubMed
Heide, W., Blankenburg, M., et al. (1995). Cortical control of double-step saccades: Implications for spatial orientation. Ann. Neurol., 38, 739–48.CrossRefGoogle ScholarPubMed
Holmes, G. (1918). Disturbances of visual orientation. Brit. J. Ophthalmol., 2, 449–68, 506–18.CrossRefGoogle ScholarPubMed
Hijdra, A. and Meerwaldt, J. D. (1984). Balint's syndrome in a man with border-zone infarcts caused by atrial fibrillation. Clin. Neurol. Neurosurg., 86(1), 51–4.CrossRefGoogle Scholar
Husain, M. and Stein, J. (1988). Rezso Balint and his most celebrated case. Arch. Neurol., 45(1), 89–93.CrossRefGoogle ScholarPubMed
Inoue, A., Sato, K., et al. (1988). A case of multiple cerebral hemorrhage related to cerebral amyloid angiopathy. No Shinkei Geka, 16 (Suppl. 5), 544–9.Google ScholarPubMed
Inouye, T. (1904). Cited by Rizzo and Vecera (2002).
Jackson, S. R., Newport, R., et al. (2005). Where the eye looks, the hand follows; limb-dependent magnetic misreaching in optic ataxia. Curr. Biol., 15(1), 42–6.Google ScholarPubMed
Jakobson, L. S., Archibald, Y. M., et al. (1991). A kinematic analysis of reaching and grasping movements in a patient recovering from optic ataxia. Neuropsychologia, 29(8), 803–9.CrossRefGoogle Scholar
Jeannerod, M., Decety, J., et al. (1994). Impairment of grasping movements following bilateral posterior parietal lesion. Neuropsychologia, 32, 369–80.CrossRefGoogle ScholarPubMed
Karnath, H. O. and Perenin, M. T. (2005). Cortical control of visually guided reaching: Evidence from patients with optic ataxia. Cereb. Cortex, 15(10), 1561–9.CrossRefGoogle ScholarPubMed
Kase, C. S., Troncoso, J. F., et al. (1977). Global spatial disorientation. Clinico-pathologic correlations. J. Neurol. Sci., 34(2), 267–78.CrossRefGoogle ScholarPubMed
Kerkhoff, G. (2000). Neurovisual rehabilitation: Recent developments and future directions. J. Neurol. Neurosurg. Psychiatr., 68, 691–706.CrossRefGoogle ScholarPubMed
Kerkhoff, G. (2001). Neurovisual rehabilitation in Balint's syndrome: Reply. J. Neurol. Neurosurg. Psychiat., 70, 416.Google Scholar
Luria, A. R. (1959). Disorders of simultaneous perception in a case of occipito-parietal brain injury. Brain, 82, 437–49.CrossRefGoogle Scholar
Mendez, M. F., Tomsak, R. L. and Remler, B. (1990). Disorders of the visual system in Alzheimer's disease. J. Clin. Neuroophthalmol., 10, 62–9.Google ScholarPubMed
Michel, F. and Henaff, M. A. (2004). Seeing without the occipito-parietal cortex: Simultagnosia as a shrinkage of the attentional visual field. Behav. Neurol., 15(1-2), 3–13.CrossRefGoogle ScholarPubMed
Michel, F., Jeannerod, M., et al. (1963). Un cas de désorientation visuelle dans les trois dimensions de l'espace (A propos du syndrome de Balint et du syndrome décrit par G Holmes). Rev. Neurol. (Paris), 108, 983–4.Google Scholar
Montero, J., Pena, J., et al. (1982). Balint's syndrome. Report of four cases with watershed parieto-occipital lesions from vertebrobasilar ischemia or systemic hypotension. Acta Neurol. Belg., 82(5), 270–80.Google ScholarPubMed
Müri, R. M., Iba-Zizen, M. T., et al. (1996). Location of the human posterior eye field with functional magnetic resonance imaging. J. Neurol. Neurosurg. Psychiat., 60, 445–48.CrossRefGoogle ScholarPubMed
Perenin, M. T. and Vighetto, A. (1988). Optic ataxia: A specific disruption in visuomotor mechanisms. I. Different aspects of the deficit in reaching for objects. Brain, 111(Pt 3), 643–74.CrossRefGoogle ScholarPubMed
Perez, F. M., Tunkel, R. S., et al. (1996). Balint's syndrome arising from bilateral posterior cortical atrophy or infarction: Rehabilitation strategies and their limitation. Disabil. Rehabil., 18(6), 300–4.CrossRefGoogle ScholarPubMed
Pierrot-Deseilligny, C., Gautier, J. C., et al. (1988). Acquired ocular motor apraxia due to bilateral frontoparietal infarcts. Ann. Neurol., 23(2), 199–202.CrossRefGoogle ScholarPubMed
Pierrot-Deseilligny, C., Gray, F., et al. (1986). Infarcts of both inferior parietal lobules with impairment of visually guided eye movements, peripheral visual inattention and optic ataxia. Brain, 109, 81–97.CrossRefGoogle ScholarPubMed
Pisella, L., Grea, H., et al. (2000). An ‘automatic pilot’ for the hand in human posterior parietal cortex: Toward reinterpreting optic ataxia. Nat. Neurosci., 3(7), 729–36.CrossRefGoogle ScholarPubMed
Prado, J., Clavagnier, S., et al. (2005). Two cortical systems for reaching in central and peripheral vision. Neuron, 48, 849–58.CrossRefGoogle ScholarPubMed
Rapcsak, S. Z., Cimino, C. R., et al. (1988). Altitudinal neglect. Neurology, 38(2), 277–81.CrossRefGoogle ScholarPubMed
Riddoch, G. (1935). Visual disorientation in homonymous half-fields. Brain, 58, 376–82.CrossRefGoogle Scholar
Rizzo, M. and Hurtig, R. (1987). Looking but not seeing: Attention, perception, and eye movements in simultanagnosia. Neurology, 37, 1642–8.CrossRefGoogle Scholar
Rizzo, M. and Vecera, S. P. (2002). Psychoanatomical substrates of Balint's syndrome. J. Neurol. Neurosurg. Psychiatry, 72(2), 162–78.CrossRefGoogle ScholarPubMed
Rizzolatti, G. and Matelli, M. (2003). Two different streams form the dorsal visual system: anatomy and functions. Exp. Brain Res., 153(2), 146–57.CrossRefGoogle ScholarPubMed
Rondot, P., Recondo, J., et al. (1977). Visuomotor ataxia. Brain, 100(2), 355–76.CrossRefGoogle ScholarPubMed
Rosselli, M., Ardila, A., et al. (2001). Rehabilitation of Balint's syndrome: A single case report. Appl. Neuropsychol., 8(4), 242–7.CrossRefGoogle ScholarPubMed
Rossetti, Y. (1998). Implicit short-lived motor representations of space in brain damaged and healthy subjects. Consciousness and Cognition, 7, 520–58.CrossRefGoogle ScholarPubMed
Rossetti, Y., Pisella, L., et al. (2003). Optic ataxia revisited: Visually guided action versus immediate visuomotor control. Exp. Brain Res., 153(2), 171–9.CrossRefGoogle ScholarPubMed
Rossetti, Y., Revol, P., et al. (2005). Visually guided reaching: Bilateral posterior parietal lesions cause a switch from fast visuomotor to slow cognitive control. Neuropsychologia, 43(2), 162–77.CrossRefGoogle Scholar
Roy, A. C., Stefanini, S., et al. (2004). Early movement impairments in a patient recovering from optic ataxia. Neuropsychologia, 42(7), 847–54.CrossRefGoogle Scholar
Schindler, I., Rice, N. J., et al. (2004). Automatic avoidance of obstacles is a dorsal stream function: Evidence from optic ataxia. Nat. Neurosci., 7(7), 779–84.CrossRefGoogle ScholarPubMed
Schluppeck, D., Glimcher, P. and Heeger, D. J. (2005). Topographic organization for delayed saccades in human posterior parietal cortex. J. Neurophysiol., 94, 1372–84.CrossRefGoogle ScholarPubMed
Tang-Wai, D. F., Graff-Radford, N. R., et al. (2004). Clinical, genetic, and neuropathologic characteristics of posterior cortical atrophy. Neurology, 63(7), 1168–74.CrossRefGoogle ScholarPubMed
Tyler, H. R. (1968). Abnormalities of perception with defective eye movements (Balint's syndrome). Cortex, 4, 154–71.CrossRefGoogle Scholar
Valenza, N., Murray, M. M., et al. (2004). The space of senses: Impaired crossmodal interactions in a patient with Balint syndrome after bilateral parietal damage. Neuropsychologia, 42(13), 1737–48.CrossRefGoogle Scholar
Verfaellie, M., Rapcsak, S. Z., et al. (1990). Impaired shifting of attention in Balint's syndrome. Brain Cogn., 12(2), 195–204.CrossRefGoogle ScholarPubMed
Vighetto, A. and Perenin, M. T. (1981). Ataxie optique: Analyse des réponses oculaires et manuelles lors du pointage vers des cibles visuelles. Rev. Neurol., 137(5), 357–72.Google Scholar
Watson, R. T. and Rapcsak, S. Z. (1989). Loss of spontaneous blinking in a patient with Balint's syndrome. Arch. Neurol., 46(5), 567–70.CrossRefGoogle Scholar
Woldorff, M. G., Hazlitt, C. J., et al. (2004). Functional parcellation of attentional control region of the brain. J. Cogn. Neurosci., 16, 149–65.CrossRefGoogle Scholar
Zihl, J. (2000). Rehabilitation of visual disorders after brain injury. In Neuropsychological Rehabilitation: A Modular Handbook. Hove: Psychology Press Ltd.

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

  • Bálint's syndrome
    • By Alain Vighetto, Hôpital neurologique Pierre Wertheimer, Lyon and Université Claude Bernard Lyon I, Pierre Krolak-Salmon, Hôpital neurologique Pierre Wertheimer, Lyon and Université Claude Bernard Lyon I
  • Edited by Olivier Godefroy, Université de Picardie Jules Verne, Amiens, Julien Bogousslavsky, Université de Lausanne, Switzerland
  • Book: The Behavioral and Cognitive Neurology of Stroke
  • Online publication: 10 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544880.016
Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Bálint's syndrome
    • By Alain Vighetto, Hôpital neurologique Pierre Wertheimer, Lyon and Université Claude Bernard Lyon I, Pierre Krolak-Salmon, Hôpital neurologique Pierre Wertheimer, Lyon and Université Claude Bernard Lyon I
  • Edited by Olivier Godefroy, Université de Picardie Jules Verne, Amiens, Julien Bogousslavsky, Université de Lausanne, Switzerland
  • Book: The Behavioral and Cognitive Neurology of Stroke
  • Online publication: 10 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544880.016
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Bálint's syndrome
    • By Alain Vighetto, Hôpital neurologique Pierre Wertheimer, Lyon and Université Claude Bernard Lyon I, Pierre Krolak-Salmon, Hôpital neurologique Pierre Wertheimer, Lyon and Université Claude Bernard Lyon I
  • Edited by Olivier Godefroy, Université de Picardie Jules Verne, Amiens, Julien Bogousslavsky, Université de Lausanne, Switzerland
  • Book: The Behavioral and Cognitive Neurology of Stroke
  • Online publication: 10 October 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511544880.016
Available formats
×