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Neurocase Dec 2022A 66-year-old left-handed male was admitted to our acute inpatient rehabilitation (AIR) unit following a resection of the right occipito-parietal glioblastoma. He...
A 66-year-old left-handed male was admitted to our acute inpatient rehabilitation (AIR) unit following a resection of the right occipito-parietal glioblastoma. He presented with symptoms of horizontal oculomotor apraxia, contralateral optic ataxia and left homonymous hemianopsia. We diagnosed this patient with partial Bálint's syndrome (BS)- oculomotor apraxia, optic ataxia but not simultanagnosia. BS is typically caused by bilateral posterior parietal lesions, but we here describe a unique case due toresection of a right intracranial tumor. A short AIR stay allowed our patient to learn how to compensate for visuomotor and visuospatial deficits, and improved his quality of life significantly.
Topics: Humans; Male; Aged; Agnosia; Hemianopsia; Glioblastoma; Quality of Life; Ataxia; Apraxias; Brain Diseases
PubMed: 36794351
DOI: 10.1080/13554794.2023.2176778 -
Cortex; a Journal Devoted To the Study... May 2020Visual imagery, like vision as such, is widely thought to be supported by two distinct and dissociable processing streams, dedicated to object representation and spatial...
Visual imagery, like vision as such, is widely thought to be supported by two distinct and dissociable processing streams, dedicated to object representation and spatial analysis respectively. However, this simple dichotomy has been contested, with recent studies suggesting that impairments in perception-for-action and visuo-spatial imagery may reflect a more general deficit in space-based attention. Although previous studies have revealed the impact of brain damage on artistic expression, few have examined the impact on artistic expression in terms of the perceptual and spatial components of either visual processing or visual imagery. Here we present the case of an artist whose artistic expression was dramatically affected following devastating posterior brain damage. Of particular interest, we demonstrate how these changes relate to impairments in integrating and aligning different spatial features in both visual processing and visual imagery, suggestive of a general simultanagnosia not previously described.
Topics: Attention; Humans; Imagination; Infarction; Space Perception; Spatial Processing; Visual Perception
PubMed: 32171493
DOI: 10.1016/j.cortex.2020.01.023 -
Neurocase Dec 2020We report a patient with asymmetric Bálint's syndrome (predominantly right-sided oculomotor apraxia and simultanagnosia and optic ataxia for the right hemispace), and...
Asymmetric Bálint's syndrome with multimodal agnosia, bilateral agraphesthesia, and ineffective kinesthetic reading due to subcortical hemorrhage in the left parieto-occipito-temporal area.
We report a patient with asymmetric Bálint's syndrome (predominantly right-sided oculomotor apraxia and simultanagnosia and optic ataxia for the right hemispace), and multimodal agnosia (apperceptive visual agnosia and bilateral associative tactile agnosia) with accompanying right hemianopia, bilateral agraphesthesia, hemispatial neglect, global alexia with unavailable kinesthetic reading, and lexical agraphia for kanji (Japanese morphograms), after hemorrhage in the left parieto-occipito-temporal area. The coexistence of tactile agnosia, bilateral agraphesthesia, and ineffective kinesthetic reading suggests that tactile-kinesthetic information can be interrupted because of damage to the fiber connection from the parietal lobe to the occipito-temporal area, leading to these tactually related cognitive impairments.
Topics: Aged; Agnosia; Agraphia; Apraxias; Ataxia; Cerebral Hemorrhage; Cogan Syndrome; Dyslexia; Humans; Language Disorders; Magnetic Resonance Imaging; Male; Occipital Lobe; Parietal Lobe; Perceptual Disorders; Syndrome; Temporal Lobe; Touch Perception; Visual Perception
PubMed: 33103577
DOI: 10.1080/13554794.2020.1831546 -
Neuropsychologia Jan 2020Humans possess the remarkable capacity to assess the numerosity of a set of items over a wide range of conditions, from a handful of items to hundreds of them. Recent...
Humans possess the remarkable capacity to assess the numerosity of a set of items over a wide range of conditions, from a handful of items to hundreds of them. Recent evidence is starting to show that judgments over such a large range is possible because of the presence of three mechanisms, each tailored to specific stimulation conditions. Previous evidence in favour of this theory comes from the fact that discrimination thresholds and estimation reaction times are not constants across numerosity levels. Likewise, attention is capable of dissociating the three mechanisms: when healthy adult observers are asked to perform concurrently a taxing task, the judgments of low numerosities (<4 dots) or of high numerosities is affected greatly, not so however for intermediate numerosities. Here we bring evidence from a neuropsychological perspective. To this end we measured perceptual performance in PA, a 41 year-old patient who suffers simultanagnosia after a hypoxic brain injury. PA showed a profound deficit in attentively tracking objects over space and time (multiple object tracking), even in very simple conditions where controls made no errors. PA also showed a massive deficit on sensory thresholds when comparing dot-arrays containing extremely low (3 dots) or extremely high (64, 128 dots) numerosities as well as in comparing dot-distances. Surprisingly, PA discrimination thresholds were relatively spared for intermediate numerosity (12 and 16 dots). Overall his deficit on the numerosity task results in a U-shape function across numerosity which, combined with the attentional deficit and the inability to judge dot-distances, confirms previously suggested three-systems for numerosity judgments.
Topics: Adult; Humans; Hypoxia, Brain; Male; Mathematical Concepts; Pattern Recognition, Visual; Perceptual Disorders; Single-Case Studies as Topic; Space Perception
PubMed: 31726066
DOI: 10.1016/j.neuropsychologia.2019.107259 -
European Journal of Neurology Jan 2021Posterior cortical atrophy (PCA) is a rare neurodegenerative syndrome, defined by a distinctive clinical-radiological profile, with Alzheimer's disease (AD) pathology...
BACKGROUND AND PURPOSE
Posterior cortical atrophy (PCA) is a rare neurodegenerative syndrome, defined by a distinctive clinical-radiological profile, with Alzheimer's disease (AD) pathology accounting for the majority of cases. The aim of this report was to present the case of a patient with impairment of visual and constructional abilities as initial manifestations.
METHOD
The patient underwent a multidimensional assessment, including neuropsychological evaluation, structural and functional imaging and genetic screening.
RESULTS
Neurological and neuropsychological assessment showed an impairment of constructive and visuo-spatial skills, associated with dyscalculia, simultanagnosia, optic ataxia and oculomotor apraxia. In accordance with the latest consensus criteria, a diagnosis of PCA was made. Consistent with the clinical findings, structural and functional imaging showed a peculiar pattern of atrophy with primary involvement of right parieto-occipital cortices, whereas cerebrospinal fluid biochemical analysis did not reveal a profile compatible with AD pathology. Genetic screening identified a known pathogenic GRN mutation.
CONCLUSION
We present a case of PCA in a GRN mutation carrier in whom a concomitant AD pathological process was excluded. Consequently, although lacking histological data, our case suggests GRN-related pathology causative of PCA. Through this report we provide further evidence for a new neurodegenerative pathway leading to PCA, extending the clinical spectrum of GRN-associated phenotypes.
Topics: Alzheimer Disease; Atrophy; Cerebral Cortex; Humans; Mutation; Occipital Lobe; Progranulins
PubMed: 33030763
DOI: 10.1111/ene.14574 -
Neuro-ophthalmology (Aeolus Press) 2024Vision specialists will benefit from increased awareness of posterior cortical atrophy (PCA) syndrome. Failure to adequately identify the chief complaint as a visual...
Vision specialists will benefit from increased awareness of posterior cortical atrophy (PCA) syndrome. Failure to adequately identify the chief complaint as a visual symptom may lead to incorrect diagnosis or diagnostic delay. A previously healthy, 59-year-old woman presented with a 5-year history of 'losing her stuff'. Upon psychiatric and neuro-ophthalmological evaluation, this symptom was better recognised as a feature of visual agnosia and simultanagnosia. She also presented with multiple previously unrecognised symptoms indicative of higher visual processing dysfunction, such as alexia without agraphia, ocular motor apraxia, optic ataxia, prosopagnosia, akinetopsia and topographagnosia, so further assessment to investigate for PCA was carried out. After a work-up including cognitive assessment, brain structural/functional imaging, and laboratory tests she was diagnosed with visual-variant Alzheimer's disease. Patients with PCA merit a detailed review of their symptoms, as well as the use of office tests such as cognitive evaluation tools, different types of perimetry, colour vision tests, and non-delayed psychiatric consultation for correct management and assessment. This report will emphasise five key aspects to be considered when evaluating patients with PCA.
PubMed: 38357623
DOI: 10.1080/01658107.2023.2257311 -
Nederlands Tijdschrift Voor Geneeskunde Feb 2020Bálint's syndrome is characterized by the triad of ocular apraxia, dorsal simultanagnosia and optic ataxia. It most commonly occurs following bilateral...
BACKGROUND
Bálint's syndrome is characterized by the triad of ocular apraxia, dorsal simultanagnosia and optic ataxia. It most commonly occurs following bilateral parieto-occipital brain injury, for which several aetiologies have been described.
CASE DESCRIPTION
We present a case of a 39-year-old male with penetrating brain injury following a suicide attempt with a crossbow. A CT scan of the head revealed the intracranial position of the arrow, piercing the parietal and occipital cortex from the left-parietal direction with the tip on the right parietal bone. After surgical removal of the arrow, visuospatial symptoms persisted that were consistent with Bálint's syndrome. The characteristic symptoms, patho-anatomy and treatment of this syndrome are discussed in this article.
CONCLUSION
The patient in this case had visual impairment following a suicide attempt with a crossbow. On the basis of neurological and neuropsychological assessments, the triad of ocular apraxia, dorsal simultanagnosia and optic ataxia was observed, characteristic of Bálint's syndrome.
Topics: Adult; Apraxias; Humans; Male; Neuropsychological Tests; Parietal Bone; Parietal Lobe; Suicide, Attempted; Vision Disorders; Wounds, Penetrating
PubMed: 32073797
DOI: No ID Found -
Neurocase Apr 2020We assessed visuospatial abilities in PCA. Sequential display of two simple geometric figures enhanced detection and discrimination relative to simultaneous display...
We assessed visuospatial abilities in PCA. Sequential display of two simple geometric figures enhanced detection and discrimination relative to simultaneous display (Exps 1 & 2). Comparing edges of a single object enhanced discrimination relative to comparing edges of two separate objects, consistent with object-based attention (Exp. 3). Recognition of complex line drawings was spared for a single object but disrupted by an attention-grabbing small circle (Exp. 4). A covert orienting task showed difficulty disengaging from previous locations and attentional bias toward the right visual field (Exp. 5). These findings shed light on the role of visual attention in perceptual awareness.
Topics: Aged; Atrophy; Attention; Discrimination, Psychological; Humans; Male; Neurodegenerative Diseases; Occipital Lobe; Parietal Lobe; Pattern Recognition, Visual; Perceptual Disorders; Space Perception
PubMed: 32070200
DOI: 10.1080/13554794.2020.1729385 -
Neurocase Dec 2019This paper presents a follow-up of a child with Balint's syndrome over more than a decade. The patient experienced traumatic brain injury before age 12, resulting in...
This paper presents a follow-up of a child with Balint's syndrome over more than a decade. The patient experienced traumatic brain injury before age 12, resulting in bilateral occipito-parietal infarctions and a clinical presentation of Balint's syndrome. Neuropsychological assessments at three time points showed average verbal abilities alongside persistent difficulties in visual orientation, mirrored in the patient's daily life. Her outstanding compensatory abilities in the face of these impairments are discussed with respect to the recruitment of the ventral visual stream and the role of top-down processing. This profile may help to determine interventions for younger patients with similar lesions.
Topics: Brain Injuries, Traumatic; Child; Female; Follow-Up Studies; Humans; Neuropsychological Tests; Occipital Lobe; Parietal Lobe; Recovery of Function
PubMed: 31571528
DOI: 10.1080/13554794.2019.1668420