“It was a quiet Thursday afternoon when A.S., a 68-year-old woman from a suburb of Chicago, awakened from a nap to the realization that something was terribly wrong,” begins a remarkable article in the September 11 issue of the journal Neurology.
“‘I went to lie down, and when I got up, I couldn’t find where the cabinets were, or the doors,’ she remembers. Over the next 2 days, A.S.’s confusion heightened as she increasingly lost her ability to name or even distinguish household objects that she’d been surrounded by for years.”
A.S. did not know it at the time, but she was suddenly suffering from something called Bálint's syndrome.
First described in 1907 by a Hungarian named Rezsö Bálint, people with the condition lose the ability to make sense of their visual field and coordinate their physical movements in response.
“If you ask somebody if they see a glass, or a toothbrush, they’ll say yes,” explained Loyola University of Chicago Stritch School of Medicine neurologist Murray Flaster, who is one of the article’s authors. “Then if you ask if they can pick it up, they can’t. There’s nothing wrong with their movements or their eyes. They just can’t easily understand how to reach the glass.”
The problem, Flaster said, is that one or more critical parts of the visual brain have been injured, most commonly by a stroke.
When we see normally, the data enters our eyes, travels along the optic nerve and reaches the brain. Eventually our visual cortex assembles the data – shapes, context, dimensions and so on – into a coherent picture.
A stroke or some other event can injure key areas around the visual cortex called “association areas.” “Our educated guess,” Flaster explained, “is that it is in these areas that we process visual images and relate them to a visual field. We can recognize each item. For instance, if a pen moved on my desk I would recognize it as a pen. But the ability to recognize relationships of objects and where they are becomes impaired.”
In other words, the associations between objects and their context isn’t getting made. “You cannot assemble the discrete elements,” Flaster said. “You can’t extract useful information from the image.”
It’s a little like another condition known as alexia without agraphia. There, patients can write full sentences, but they can’t read them because they can’t make sense of letters and words they’ve just written, though they can see them just fine.
Needless to say, this is a serious problem. Thankfully, it’s also rare. Flaster suggests that a neurologist might see a dozen cases over an entire career. Because there are gradations of severity, Bálint syndrome could be missed by physicians, Flaster said. Some cases might resolve on their own, but most won’t, and there’s no cure nor therapy.
Instead, patients have to adapt. A.S., for example, puts toothpaste directly into her mouth, then grasps the toothbrush and, by trial and error, puts it in her mouth and scrubs. Once an avid reader, she now relies on audiobooks. Her family figured out that putting bright yellow tape around doorways helped A.S. navigate.
A diagnosis “can be a devastating blow” Flaster said, but patients are often also relieved to at least know that what’s gone haywire in their brains has an explanation.
Brian Alexander (www.BrianRAlexander.com) is co-author, with Larry Young PhD., of "The Chemistry Between Us: Love, Sex and the Science of Attraction," (www.TheChemistryBetweenUs.com) to be released Thursday.
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