Neuro-ophthalmological features in a case of Bálint's syndrome Kenji Yuda 1 1Dept of Ophthalmol, Yokohama City Univ Sch of Med pp.1249-1254
Published Date 1988/11/15
DOI https://doi.org/10.11477/mf.1410210545
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A 67-year-old right-handed male manifested Bálint's syndrome after recovering from an attack of cerebral infarction. The clinical manifestations included psychic paralysis of visual perception, optic ataxia and disturbance of visual attention. Computed tomography showed low-density areas in the lower parietal and occipital lobes of both cerebral hemispheres, in addition to low-density areas surrounding the central sulcus of the left cerebral hemisphere.

The visual acuity was 0.4 each. Perimetry showed homonymous lower right quandrantanopsia with concentric contraction. He behaved like a bling person and could not reach visible objects. Forced traction of the eyes induced no sense of motion of surroundings. This seemed to mean that the coor-dinating system of the visual space of the patient was destroyed by the cerebral infarction. He could turn his eyes to all directions responding to oral command but failed to visually induce saccadic eye movements in any direction. Smooth pursuit move-ment of the eyes could be induced only when the visual targets were moved very slowly. By EOG, thevelocity of smooth pursuit eye movement in the right direction was constant irrespective of the velocity of the moving object. Left-beat nystagmus instead of smooth pursuit movement was elicited when the eyes trucked the target in the left direc-tion. The finding seemed to imply that the cells responsible for the velocity and direction of eye movement existed on both parietal lobes. The optokinetic nystagmus (OKN) was asym-metric. The rightward OKN was of small ampli-tude and the leftward one was of large amplitude. The velocities of slow phase OKN and of smooth pursuit movement were constant in either direction independent of target velocity. Vestibulo-ocular reflex (VOR) was induced normally. Visual sup-pression of VOR was absent due to inattention to the visual target.

These findings suggested that the visual suppres-sion, which is believed to be induced by coordina-tion of the secondary visual system and the cerebel-lum, is influenced by the higher-level center in the brain, particularly the parietal lobes.

Rinsho Ganka (Jpn J Clin Ophthalmol) 42(11) : 1249-1254, 1988

Copyright © 1988, Igaku-Shoin Ltd. All rights reserved.


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