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1516 - Balint Syndrome following Chiropractic Activator Method: A Case Report

Thursday, February 27, 2025

5:00 PM - 6:30 PM MST

Presenting Author(s)

BK

Brian Khin, DO

Resident
KPC Health Transitional Year Program
Arcadia, California, United States

Co-Author(s)

HK

Haroon Kisana, MD

Resident
HonorHealth PM&R Program
Scottsdale, Arizona, United States
JI

Joanna Israel, DO

Medical Director of HonorHealth Osborn Medical Center
HonorHealth PM&R Program
Scottsdale, Arizona, United States

Case Diagnosis: Balint Syndrome

Case Description: A 78-year-old female with past medical history of migraines, cataracts, and hypertension presented to the hospital with two days of bilateral vision loss and difficulty navigating. The patient was diagnosed two months prior with Polymyalgia Rheumatica from persistent headaches with chronic neck pain, for which she was started on Prednisone. Patient received a chiropractic neck adjustment using activator method the day prior to symptom onset. On exam, she had decreased peripheral vision, bilateral cortical blindness, simultanagnosia, optic ataxia, and negative blink-to-threat. NIHSS was 3. CT head showed subacute ischemic infarcts involving parieto-occipital areas and left cerebellar hemisphere with luminal narrowing of left Vertebral V2 segment and occlusion of left V3 and V4 segments, concerning for cervical artery dissection.
Presentation was consistent with subacute ischemic stroke syndrome predominantly involving the bilateral occipital areas of the Left Cerebellar Hemisphere and Posterior circulation territory, which manifested clinically with cortical blindness and Balint Syndrome.

Discussions: Balint Syndrome is a rare clinical presentation of cerebrovascular accidents resulting in simultanagnosia, optic ataxia, and oculomotor apraxia. The diagnosis is primarily clinical and is associated with bilateral parieto-occipital lobe injury. Prognosis is variable depending on the extent of brain damage. While some recovery can be expected with rehabilitation, many will continue to experience difficulties post recovery.

The patient presented to Acute Rehabilitation Hospital with visual loss, balance deficits, and difficulty navigating requiring Minimal Assist. She was discharged home as Modified-Independent with four-wheel-walker.

Conclusions: This case demonstrates a unique clinical presentation of Balint Syndrome in a 78-year-old female with many risk factors and following Chiropractic care. It stresses the importance of collaboration and communication during interdisciplinary care.