Posterior Reversible Encephalopathy Syndrome Presenting as Balint Syndrome

Abstract

Balint syndrome is a disorder of inaccurate visually guided saccades, optic ataxia, and simultanagnosia that typically results from bilateral parieto-occipital lesions. Visual perception disturbances in the posterior reversible encephalopathy syndrome (PRES) include hemianopia, visual neglect, and cerebral blindness, but Balint syndrome had not been recognized. We report Balint syndrome associated with PRES in a 37-year-old woman with acute hypertension and systemic lupus erythematosus. Balint syndrome can be an initial presentation of PRES.

Optic Ataxia: From Balint’s Syndrome to the Parietal Reach Region

“…Brain tumors affecting the bilateral parietal lobes include CNS lymphomas and “butterfly tumors”, which are often caused by high-grade astrocytomas or glioblastoma multiforme, a common malignant tumor that can cross the corpus collosum (Rafal, 2001). Balint’s syndrome has been seen in posterior reversible encephalopathy syndrome (PRES), a syndrome caused by vasogenic edema, most commonly affecting the parietal and occipital cortex and underlying white matter, and may be seen secondary to a variety of medical conditions including malignant hypertension, eclampsia and pre-eclampsia in pregnancy, high dose chemotherapy, post-transplant immunosuppressive drugs and renal disease (Fugate et al, 2010; Kumar et al, 2011; Gurjinder, 1989). Infectious processes have been reported to cause optic ataxia in Balint’s syndrome including cerebral toxoplasmosis and progressive multifocal leukoencephalopathy secondary to the JC Virus in immunocompromised patients with HIV (Ayuso-Peralta et al, 1994; Garcia Guijo et al, 1990), and in herpes encephalitis in an infant (Amin et al, 2012).…”

Balint syndrome

“…Etiologies[2] include trauma, post-cardiac arrest, near drowning, stroke, metastasis,[3] eclampsia,[4] human immunodeficiency virus encephalitis, posterior reversible encephalopathy, posterior cortical atrophy[5] and Creuzfeldt-Jacob disease.…”

Ocular Dysfunctions Presenting in Tacrolimus‐Induced Posterior Reversible Encephalopathy Syndrome: A Case Presentation

“…Such visual deficits typically include hemianopia, visual neglect, and cerebral blindness. Ocular dysfunctions including optic ataxia, ocular apraxia, simultanagnosia, and depth perception deficits have rarely been described in tacrolimus‐induced PRES [4]. Here we describe a lung transplant recipient who was found to have tacrolimus‐induced PRES, whose initial presentation included visual symptoms, compatible with Balint syndrome, along with impaired depth perception.…”