Rizzo M, Vecera S P
University of Iowa College of Medicine, Department of Neurology, 200 Hawkins Drive, Iowa City, IA 52242-1053, USA.
J Neurol Neurosurg Psychiatry. 2002 Feb;72(2):162-78. doi: 10.1136/jnnp.72.2.162.
From a series of glimpses, we perceive a seamless and richly detailed visual world. Cerebral damage, however, can destroy this illusion. In the case of Bálint's syndrome, the visual world is perceived erratically, as a series of single objects. The goal of this review is to explore a range of psychological and anatomical explanations for this striking visual disorder and to propose new directions for interpreting the findings in Bálint's syndrome and related cerebral disorders of visual processing.
Bálint's syndrome is reviewed in the light of current concepts and methodologies of vision research.
The syndrome affects visual perception (causing simultanagnosia/visual disorientation) and visual control of eye and hand movement (causing ocular apraxia and optic ataxia). Although it has been generally construed as a biparietal syndrome causing an inability to see more than one object at a time, other lesions and mechanisms are also possible. Key syndrome components are dissociable and comprise a range of disturbances that overlap the hemineglect syndrome. Inouye's observations in similar cases, beginning in 1900, antedated Bálint's initial report. Because Bálint's syndrome is not common and is difficult to assess with standard clinical tools, the literature is dominated by case reports and confounded by case selection bias, non-uniform application of operational definitions, inadequate study of basic vision, poor lesion localisation, and failure to distinguish between deficits in the acute and chronic phases of recovery.
Studies of Bálint's syndrome have provided unique evidence on neural substrates for attention, perception, and visuomotor control. Future studies should address possible underlying psychoanatomical mechanisms at "bottom up" and "top down" levels, and should specifically consider visual working memory and attention (including object based attention) as well as systems for identification of object structure and depth from binocular stereopsis, kinetic depth, motion parallax, eye movement signals, and other cues.
通过一系列瞬间瞥见，我们感知到一个无缝且细节丰富的视觉世界。然而，脑损伤会破坏这种错觉。在Balint综合征的病例中，视觉世界被不稳定地感知为一系列单个物体。本综述的目的是探讨对这种显著视觉障碍的一系列心理学和解剖学解释，并为解释Balint综合征及相关视觉处理脑疾病的研究结果提出新方向。
根据当前视觉研究的概念和方法对Balint综合征进行综述。
该综合征影响视觉感知（导致同时失认/视觉定向障碍）以及眼和手运动的视觉控制（导致眼性失用和视觉性共济失调）。尽管它通常被解释为双侧顶叶综合征，导致一次只能看到一个以上物体的能力丧失，但其他病变和机制也是可能的。关键综合征成分是可分离的，并且包括一系列与偏侧空间忽视综合征重叠的障碍。Inouye在1900年开始对类似病例的观察早于Balint的最初报告。由于Balint综合征并不常见，且难以用标准临床工具进行评估，文献主要由病例报告主导，并受到病例选择偏倚、操作定义应用不统一、基本视觉研究不足、病变定位不佳以及未能区分恢复急性期和慢性期缺陷的困扰。
对Balint综合征的研究为注意力、感知和视觉运动控制的神经基质提供了独特证据。未来的研究应在“自下而上”和“自上而下”层面探讨可能的潜在心理解剖机制，并应特别考虑视觉工作记忆和注意力（包括基于物体的注意力）以及用于从双眼立体视觉、运动视差、眼动信号和其他线索识别物体结构和深度的系统。
