Floating heads: An Occi-dental discovery of bálint syndrome
Rathnam A, Affan M, and Miller D. Floating heads: An Occi-dental discovery of bálint syndrome. Neurology 2019; 92(15).
Objective: To report a case of transient Bálint Syndrome in the setting of diaschisis. Background: Bálint syndrome is the cortical visual syndrome consisting of simultagnosia, oculomotor apraxia, and optic ataxia that occurs due to damage of bilateral parieto-occipital lobes. We present a unique case of Bálint syndrome in a patient with bilateral ischemic stroke of the occipital lobes only. Design/Methods: N/A Results: A 51 year old left-handed male with relevant history of hypertension, diabetes mellitus, coronary artery disease and prior right-sided embolic stroke presents for acute generalized weakness and progressively worsening vision to the point when he could no longer feed himself or get out of the car. Upon arrival, the patient stated, “I see a lot of floating heads in the room”. He was not able to comprehend that the room was filled with people. On further examination, his visual acuity was only mildly diminished. The patient was hesitant to grasp objects with his eyes open, missing by inches each time but had no difficulty grasping objects with his eyes closed. He could not track objects with his eyes and resorted to moving his head horizontally across the room. MRI brain showed bilateral occipital infarcts, acute on the left, and acute/subacute on the right. He was admitted to the stroke unit for further workup. After 24 hours, the patient's oculomotor apraxia resolved and his simultagnosia improved, however his optic ataxia persised. Conclusions: Our patient presented with Bálint syndrome after developing bilateral occipital stroke. His parietal lobes were unaffected. This case highlights the concept of focal diaschisis. It is much more common for subcortical deficits to present this way. Very rarely do corticallyrelated clinical deficits present as a result of focal diaschisis, yet here is a patient with symptoms associated with lesions from an entirely different cortical lobe.