《认知神经科学》课程教学资源（学习资料）书籍《认知神经科学神经学基础》PDF电子版（Neurological Foundations of Cognitive Neuroscience，edited by Mark D'Esposito）

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2 Balint's Syndrome:A Disorder of Visual Cognition Robert Rafal Case Report arry on many these activities.but was able to lead a semi-independent R.M.had suffered from two strokes,both due to cardiac i流 A magnetic resonance imaging (MRI)scan in 1994 with three-dimensional reconstruction revealed nearly symmet hellum He recovered from a transient left her lons in eacn paneto-occ and left hemispatial neglect.The second stroke.in March as 7 and 30 and 1992,involved the left parietal lobe and left him func possibly included some of areas 5 and 19.In addition tionally blind.Five months after the second stroke,he was there was a small (volume <03cm)lesion in Brodmann or sensory function. nd all th obe.The The patient had normal visual acuity:he could recog gyri were intact on both sides.as were somatosensorand nize colors. motor cortices. ingle wor suffe severe spanal d Although he was ind 6 daily living.be could not maintain his own bousehold and Balint (Balint. 1909H8 1995:Ha ve had to be cared for by his family.He had to be escorted Milner,1995:Husain Stein. 1988).While only on e al in ely imsee m he ke sense obiects from him or tell which of two objects was close Fleeting to him.Optic ataxia was pronounced.He could not reach accurately toward objects,and was unable to use a pencil grasp disappear,and the to place a mark wi ithin a circle.He uld not make accu ese patients are saccades to obj ih a lly ch worl w at the ax(1919)provided a detailed of the initial neurological exam revealed an altitudina the syndrome that remains definitive emp loss of the lower visual fields.Two years later,however sized two major components of the synd (1)simultanagnosia -a constriction,no visual fields were full.Contrast ensitivity and color vision of the visual field,but of visual attention,which Three-dime restricts the patient's aware eness to only one objec depth fromsha at a time and (2)spatial disorientation- -a loss of His headaches were controlled with amitrintyline and all spatial reterence and memory that leaves the anticoagulation treatment with warfarin was instituted to patients lost in the world and unable to look at prevent further strokes.By June 1995.the patient was able objects (which Balint called "psychic paralysis of duplex next door to h gaze")or to reach for them (which Balint called optic ataxia"). He b alke in .to get about house without help. This chapter reviews the clinical and neuro- psychological aspects of this intriguing syndrome

Robert Rafal Case Report R.M. had suffered from two strokes, both due to cardiac emboli from hypertensive heart disease. The first occurred in June 1991 at the age of 54 and produced infarction in the right parietal lobe and a small lesion in the right cere￾bellum. He recovered from a transient left hemiparesis and left hemispatial neglect. The second stroke, in March 1992, involved the left parietal lobe and left him func￾tionally blind. Five months after the second stroke, he was referred to a neurologist for headaches. At that time, neurological examination revealed a classical Bálint’s syndrome without any other deficits of cognitive, motor, or sensory function. The patient had normal visual acuity; he could recog￾nize colors, shapes, objects, and faces and could read single words. He suffered severe spatial disorientation, however, and got lost easily anywhere except in his own home. Although he was independent in all activities of daily living, he could not maintain his own household and had to be cared for by his family. He had to be escorted about the hospital. When shown two objects, he often saw only one. When he did report both, he did so slowly and seemed to see them sequentially. Depth perception was severely impaired and he could not judge the distance of objects from him or tell which of two objects was closer to him. Optic ataxia was pronounced. He could not reach accurately toward objects, and was unable to use a pencil to place a mark within a circle. He could not make accu￾rate saccades to objects and he could not make pursuit eye movements to follow the most slowly moving object. Visual acuity was 20/15 in both eyes. Perimetry at the time of the initial neurological exam revealed an altitudinal loss of the lower visual fields. Two years later, however, visual fields were full. Contrast sensitivity and color vision were normal. Three-dimensional experience of shapes in random dot stereograms was preserved and he experienced depth from shading. His headaches were controlled with amitriptyline, and anticoagulation treatment with warfarin was instituted to prevent further strokes. By June 1995, the patient was able to live independently in a duplex next door to his brother’s daughter, and needed only intermittent help in his daily activities. He was able to take unescorted walks in his neighborhood, to get about in his own house without help, 2 Bálint’s Syndrome: A Disorder of Visual Cognition watch television, eat and dress himself, and carry on many activities of daily living. He was slower than normal in these activities, but was able to lead a semi-independent life. A magnetic resonance imaging (MRI) scan in 1994 with three-dimensional reconstruction revealed nearly symmet￾rical lesions in each parieto-occipital region (Friedman￾Hill, Robertson, & Treisman, 1995). The lesions were concentrated primarily in Brodmann areas 7 and 39, and possibly included some of areas 5 and 19. In addition, there was a small (volume <0.3 cm3 ) lesion in Brodmann area 6 of the right hemisphere and asymmetrical cere￾bellar lesions (volume = 0.3 cm3 left hemisphere, 6.0 cm3 right hemisphere). The damage preserved the primary visual cortex and all the temporal lobe. The supramarginal gyri were intact on both sides, as were somatosensory and motor cortices. The syndrome represented by this patient was first described by the Hungarian neurologist Rezsö Bálint (Bálint, 1909; Harvey, 1995; Harvey & Milner, 1995; Husain & Stein, 1988). While visual acuity is preserved and patients are able to recog￾nize objects placed directly in front of them, they are unable to interact with, or make sense of, their visual environment. They are lost in space. Fleeting objects that they can recognize, but that they cannot locate or grasp, appear and disappear, and their features are jumbled together. These patients are helpless in a visually chaotic world. Holmes and Horax (1919) provided a detailed analysis of the syndrome that remains definitive. They emphasized two major components of the syndrome: (1) simultanagnosia—a constriction, not of the visual field, but of visual attention, which restricts the patient’s awareness to only one object at a time and (2) spatial disorientation—a loss of all spatial reference and memory that leaves the patients lost in the world and unable to look at objects (which Bálint called “psychic paralysis of gaze”) or to reach for them (which Bálint called “optic ataxia”). This chapter reviews the clinical and neuro￾psychological aspects of this intriguing syndrome