Bálint syndrome

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The Bálint's syndrome is a rare neurological syndrome . It describes a severe spatial disturbance of attention and orientation and consists of

  • Optical ataxia : Inability to make targeted hand or gripping movements under control of the eyes.
  • Ocular apraxia : inability to make targeted gaze movements with the eyes.
  • Simultaneous agnosia : Extreme narrowing of visual attention to individual aspects of complex images so that they cannot be understood as a whole.

Symptoms

Bálint syndrome has each of the following characteristics:

  • Disturbances in spatial orientation
  • Optical ataxia
  • Simultaneous agnosia
  • Eye disorders

However, each of the four symptoms can also occur on its own. One side of the syndrome is a visual attention disorder. The affected people mistakenly perceive the visual world as an incoherent set of individual objects. Complex images or scenes can therefore no longer be captured as a whole. This part of the syndrome is called after Wolpert. also as simultaneous agnosia . Another attention deficit is the hemineglect, which is very often associated with Bálint's syndrome ( disregarding one half of the room including one of the sides of the body), as is the case with the patient described by Bálint himself.

The other side of the syndrome is a severe spatial disorientation. The visual information obtained through the eyes can no longer be used to coordinate eye movements (ocular apraxia) and grasping movements (optical ataxia). The affected people can therefore not turn their gaze to a desired object in the field of vision. Nor can they reach for things in their field of vision or control their hands with their eyes. In most cases, the inability to read ( alexia ) and write ( agraphy ) arises . The disorder also affects the visual imagination. Finally, as a result of the spatial disorientation, there is also a reduced depth perception in space, so that distances cannot be estimated.

A case study published in Scotland in 2003 described Bálint's syndrome in a 10-year-old child who had developed endocarditis when he was three years old, resulting in bleeding in the brain. The child was introduced to the paediatricians by the parents because he had great problems at school. It couldn't read and write properly because it mixed up words and letters. In addition to these symptoms, which were interpreted as simultaneous diagnoses, the authors said that there were also all other symptoms that belong to Bálint's syndrome.

Anatomical

Bilateral (both halves of the brain are affected) parietal or parieto-occipital brain damage are the cause of the full picture of Bálint's syndrome. The lesion includes the gyrus angularis and gyrus supramarginalis located at the transition between the parietal , temporal and occipital lobes . The visual cortex is not affected . However, other brain lesions can also cause similar symptoms, for example diffuse damage in dementia or Creutzfeldt-Jakob disease , as well as functional disorders, such as in psychoses . Also described are bilateral basal ganglia lesions with isolated fixation disorders, bilateral frontal lesions, and malignant brain tumors with growth above the bar on the opposite hemisphere. The cerebral cortex of the left parietal lobe is apparently responsible for shifting attention between two objects in the field of vision, whereas shifting attention between different spatial positions is taken over by the opposite right parietal lobe.

The simultanagnosia can also occur alone, then to blame temporo-occipital regions lesions. Optical ataxia with spatial-visual disturbances such as the deteriorated assessment of distances can also occur in isolation and is then the result of one-sided damage to the upper parietal lobe. The bilateral lesion of the frontal regions or the basal ganglia can cause ocular apraxia.

Historical

Bálint's syndrome was named after Rezsö Bálint (1874–1929), a Hungarian-Austrian neurologist from Budapest . He is considered to be the first to describe the syndrome. At the same time, Inouye produced similar case reports of patients with gunshot wounds. Further detailed descriptions of Bálint's syndrome in people with gunshot wounds are from Holmes.

The patient described by Bálint had bilateral lesions of the brain after a cerebral infarction at the junction of the parietal , temporal and occipital lobes . On the left side of the brain, the cerebral cortex was also affected, which is responsible for body movement ( motor cortex ) and body perception ( somatosensory cortex ). Bálint emphasizes that the damage includes the angular gyrus on both sides , but not the visual cortex . The examination of the brain took place after the death of the patient. He had suffered several strokes in 1894, which resulted in the symptoms described by Bálint. Bálint examined the patient from 1903 until his death in 1906.

The patient could see, he could recognize colors and shapes. He was able to move his eyes in all directions, although his gaze always passed the object 35 ° due to the resulting hemineglect . If the patient had looked at an object in the field of vision, he could only perceive this and no other. This narrowing of attention affected objects of all sizes. A complex scene could no longer be overlooked. A text was perceived as an incoherent arrangement of individual letters, so that the patient could no longer read. If the patient wanted to reach for something that interested him, he did not succeed, so that he was completely helpless in everyday life. Bálint exemplifies the patient's unsuccessful attempts to light a cigar. After all, the patient could not estimate the distance and perceive spatial depth.

The patients described by Holmes suffered mainly from ocular apraxia. They could no longer direct their gaze to any object in the field of vision, regardless of whether they wanted to do so themselves, were made aware of it or were held up to them. Once they had fixed an object, they could see it, but it was difficult to keep an eye on it. Like Bálint's patient, their spatial depth perception was severely disturbed. They ran into objects, could no longer read and could no longer grasp complex situations.

See also

Individual evidence

  1. ↑ a b c d e R. Bálint: paralysis of the soul of 'looking', optical ataxia, spatial disturbance of attention. In: monthly journals for psychiatric neurology. 25, 1909, pp. 51-81.
  2. ↑ a b I. Wolpert: The simultaneous diagnosis. In: Journal for the whole of neurology and psychiatry. 93, 1924, pp. 397-415.
  3. ↑ a b c M. Rizzo, SP Vecera: Psychoanatomical substrate of Bálint's syndrome. In: Journal of Neurology Neurosurgery and Psychiatry. 72, 2002, pp. 162-178.
  4. ^ M. Husain, J. Stein: Rezso Bálint and his most celebrated case. In: Archives of Neurology . 45 (1), 1988, pp. 89-93.
  5. ↑ a b c d e f g h G. Kerkhoff, B. Heldmann: Bálint syndrome and associated disorders. In: The neurologist . 70, 1999, pp. 859-869.
  6. ↑ a b c B. Kolb, IQ Whishaw: Neuropsychology. Spectrum, 1996, ISBN 3-8274-0052-X .
  7. ^ G. Goldenberg: Neuropsychology. Elsevier, Munich 1996, ISBN 3-437-21172-2 .
  8. ↑ JA Gillen, GN Dutton: Bálint's syndrome in a 10-year-old male. In: Developmental Medicine & Child Neurology. 45, 2003, pp. 349-332.
  9. ^ JL Johnston, JA Sharpe, MJ Morrow: Spasm of fixation: a quantitative study. In: Journal of Neurological Science. 107, 1992, pp. 166-171.
  10. ↑ CO Hausser, F. Robert, N. Giard: Balint's syndrome. In: Canadian Journal of Neurological Science. 7, 1980, pp. 157-161.
  11. ^ RD Rafal: Balint syndrome. In: TE Feinberg, MJ Farah: Behavioral neurology and neuropsychology. McGraw-Hill, Boston 1997, pp. 337-356.
  12. ^ R. Egly, J. Driver, RD Rafal: Shifting visual attention between objects and logations: evidence from normal and parietal lesion subjects. In: Journal of Experimental Psychology. 123, 1994, pp. 127-161.
  13. ↑ DN Levine, R. Calvanio: A study of the visual defect in verbal alexia-simultaneously-agnosia. In: Brain. 101, 1978, pp. 65-81.
  14. ↑ MT Perenin, A. Vighetto: Optic ataxia: a specific disruption in visuomotor mechanisms. I Different aspects of the deficit in reaching for objects. In: Brain. 111, 1988, pp. 643-674.
  15. ↑ IM Allen: Exaggeration of fixation of gaze. In: New Zealand Medical Journal. 61, 1962, pp. 101-107.
  16. ^ HB Coslett, E. Saffran: Simultanagnosia. In: Brain. 114, 1991, pp. 1532-1545.
  17. ↑ T. Inouye: The visual disturbances in gunshot wounds of the cortical visual sphere. Engelmann-Verlag, Leipzig 1909.
  18. ^ A b G. Holmes: Disturbances of visual space perception. In: British Medical Journal. 2, 1919, pp. 230-233.
  19. ^ A b G. Holmes, G. Horax: Disturbances of spatial orientation and visual attention, with loss of stereoscopic vision. In: Archives of Neurology and Psychiatry . 1, 1919, pp. 385-407.