We present a unique case illustrating Posterior Cerebral Atrophy (PCA) induced Balint Syndrome.

Balint Syndrome is a rare neurological disorder characterized by symptoms affecting visual perception and spatial awareness. The syndrome presents due to a lesion of the parietal-occipital region of the brain, typically bilaterally. Patients commonly present with a classic triad of symptoms of optic ataxia, oculomotor apraxia, and simultagnosia.

A 61-year-old male with a medical history of diabetes presented with a complaint of persistent visual disturbances over a couple of years. The patient expressed difficulty finding nearby objects in his visual field and trouble reading with the inability to concentrate on the correct line. Clinical examination revealed right visual field neglect and homonymous hemianopsia, simultagnosia, optic ataxia, and severe oculomotor apraxia. Initial workup including an MRI brain noted subtle mild atrophy of the left occipital area. A PET scan of the brain revealed abnormal cortical hypometabolism most notable in the left occipital lobe and bilateral posterior temporal lobes consistent with Posterior Cerebral Atrophy.

Diagnosis of Posterior Cerebral Atrophy induced Balint Syndrome was made.

Balint Syndrome is typically attributed to ischemic infarctions in the bilateral parietal-occipital areas but has also been linked to a diverse range of etiologies, including Posterior Reversible Encephalopathy Syndrome, Alzheimer's Disease, and PCA. Our case is unique as the patient’s symptoms were ongoing for several years and the disease state was profoundly noted on exam. Despite this, his initial workup had been normal except for the MRI, which was unequivocal. The findings on the PET scan of his brain along with his clinical exam were consistent with a diagnosis of Balint Syndrome in the setting of PCA, a less common underlying pathology. In conclusion, this case underscores variability in Balint Syndrome's etiological spectrum, emphasizing a thorough evaluation to provide appropriate care for affected individuals.