Global spatial disorientation Clinico-pathologic correlations

Two patients presenting with the acute onset of bilateral parietal lobe damage showed initially the features of Balint's syndrome. After most of its manifestations had cleared, both patients exhibited severe disorders of spatial orientation: acoustic ataxia, inability to localize objects in space. In addition, 1 patient showed a topographical disorientation and abnormalities of whole body movements. This patient came to post-mortem examination, which revealed bilateral and fairly symmetrical old and recent infarctions of the superior parietal lobules. In the light of these observations and previous reports, it is suggested that the reported abnormalities of whole body movements can be explained on the basis of a visuo-motor intrahemispheric disconnection due to the bilateral lesion of the dorsal parietal lobe. In addition, the global spatial disorientation is analysed and is thought to be the manifestation of a derangement of a specific function centered in the parietal lobe. Moreover, it is pointed out that topographic disorientation does not require the concomitant failure of oculomotor mechanisms for its production. The topography of the anatomical lesion is considered in relation to current concepts on brain damage after severe hypotension and cardiac arrest. It is concluded that this group of patients is most likely at risk of developing behavioural abnormalities akin to the ones here reported.

[1]  Ataxie optique: trouble de la coordination visuo-motrice , 1974 .

[2]  R. Godwin-Austen A case of visual disorientation. , 1965, Journal of neurology, neurosurgery, and psychiatry.

[3]  B. Pillon,et al.  [Study of auditory perception disorders in bilateral temporal lesions. (3 case studies 2 of which are anatomoclinical)]. , 1971, Revue neurologique.

[4]  R. Bálint Seelenlähmung des “Schauens”, optische Ataxie, räumliche Störung der Aufmerksamkeit. pp. 51–66 , 1909 .

[5]  F. Boller,et al.  Optic ataxia: clinical-radiological correlations with the EMIscan. , 1975, Journal of neurology, neurosurgery, and psychiatry.

[6]  G. Holmes,et al.  DISTURBANCES OF SPATIAL ORIENTATION AND VISUAL ATTENTION, WITH LOSS OF STEREOSCOPIC VISION , 1919 .

[7]  W. R. Brain VISUAL DISORIENTATION WITH SPECIAL REFERENCE TO LESIONS OF THE RIGHT CEREBRAL HEMISPHERE , 1941 .

[8]  O. Zangwill,et al.  A case of topographical disorientation associated with a unilateral cerebral lesion. , 1945, Brain : a journal of neurology.

[9]  N. Geschwind The apraxias: neural mechanisms of disorders of learned movement. , 1975, American scientist.

[10]  O. Meyer Ein- und doppelseitige homonyme Hemianopsie mit Orientierungsstörungen. , 1900 .

[11]  N. Geschwind Disconnexion syndromes in animals and man. I. , 1965, Brain : a journal of neurology.

[12]  W. Scoville,et al.  LOSS OF RECENT MEMORY AFTER BILATERAL HIPPOCAMPAL LESIONS , 1957, Journal of neurology, neurosurgery, and psychiatry.

[13]  T. Peele The Neuroanatomic Basis for Clinical Neurology , 1962 .

[14]  N. Geschwind Disconnexion syndromes in animals and man. II. , 1965, Brain : a journal of neurology.

[15]  M. Critchley The parietal lobes , 1966 .

[16]  G. Holmes DISTURBANCES OF VISUAL ORIENTATION , 1918, The British journal of ophthalmology.