Balint-Holmes syndrome due to stroke following SARS-CoV-2 infection: a single-case report

Panico, Francesco; Arini, Angela; Cantone, P; Crisci, C.; Trojano, Luigi

doi:10.1007/s10072-020-04860-1

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…Current data provide evidence that vision in SARS-CoV-2–infected patient can be impaired at several levels (Table 1) (3–23). Ocular causes of impaired vision were more frequent than CNS causes (Table 1).…”

Section: Resultsmentioning

confidence: 98%

“…However, if the retina and the optic nerve were regarded as part of the CNS, CNS abnormalities were more frequently responsible for impaired vision in COVID-19 patients. Neuro-ophthalmologic causes of visual impairment detected included dacryoadenitis, conjunctivitis, tonic pupils, myasthenia, vitritis, central retinal artery occlusion/central retinal venous occlusion (CRAO/CRVO), retinitis, retinal ganglion cell dysfunction, retinal bleeding, panuveitis, anterior, ischemic optic neuropathy (AION), optic nerve stroke, optic neuritis, optic perineuritis, ischemic stroke, sinus venous thrombosis (SVT), and posterior reversible encephalopathy syndrome (3–23). Thus, impaired vision due to SARS-CoV-2 is multicausal and multilocular.…”

Section: Resultsmentioning

confidence: 99%

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SARS-CoV-2 Impairs Vision

Finsterer

Scorza

et al. 2021

Journal of Neuro-Ophthalmology

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Objectives: Affection of the central nervous system and the eyes is increasingly recognized as manifestations of a SARS-CoV-2 infection . This review aims at summarizing and discussing recent advances concerning causes and locations of impaired vision because of an infection with SARS-CoV-2. Methods: On a literature search through PubMed and ScholarOne, all available publications about COVID-19 patients with impaired vision were retrieved. Results: Visual impairment in SARS-CoV-2-infected patients may be due to infection of lacrimal glands (dacryoadenitis), conjunctivitis, tonic pupils, vitritis, central retinal artery/venous occlusion, retinitis, retinal bleeding, panuveitis, anterior ischemic optic neuropathy, optic nerve stroke, optic neuritis, optic perineuritis, or occipital ischemic stroke. Visual impairment may be the initial manifestation of SARS-CoV-2. Conclusions: This mini review shows that impaired vision may be the initial manifestation of COVID-19, that all sections of the visual tract may be affected and causative for visual impairment in COVID-19 patients, and that SARS-CoV-2 manifests along the visual tract with ischemia, focal infection, and immunological reactions.

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Section: Resultsmentioning

confidence: 98%

Section: Resultsmentioning

confidence: 99%

SARS-CoV-2 Impairs Vision

Finsterer

Scorza

et al. 2021

Journal of Neuro-Ophthalmology

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“…sexo femenino, la hipertensión arterial y el antecedente de tabaquismo (5)(6)(7)(8)(9). Fisiopatológicamente, se manifiesta cuando hay lesiones bilaterales en los lóbulos parietal posterior y occipital, que afecta la conexión entre las regiones corticales de la visión y las zonas motoras prerrolándicas (17)(18).…”

Section: Discussionunclassified

“…El síndrome de Balint (SB) fue descrito por primera vez en 1909 por el médico Reszo Balint, quien identificó en un paciente este infrecuente trastorno (1)(2)(3). A pesar de que han transcurrido más de 100 años desde su primera descripción, las estimaciones de incidencia y prevalencia del SB no están claramente documentadas en la literatura científica; la información disponible se reduce a reportes aislados de casos clínicos (1,(4)(5)(6)(7)(8)(9)(10)(11)(12). La sospecha diagnóstica se presenta ante la triada clásica de: simultagnosia, ataxia óptica y apraxia oculomotora (13).…”

Section: Introductionunclassified

Síndrome de Balint y trombosis de senos venosos cerebrales: reporte de caso

López Delgado,

Chapues Andrade,

Zambrano Urbano

et al. 2023

Acta Neurol Colomb

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Introducción: el síndrome de Balint es un trastorno neurológico infrecuente, de etiología diversa, cuya presentación incluye la triada clásica de: simultagnosia, ataxia óptica y apraxia oculomotora, síntomas secundarios asociados a lesiones parieto-occipitales, con pronóstico variable según la etiología que se encuentre. A continuación, se reporta un caso secundario a una trombosis de senos venosos. Presentación del caso: mujer de 66 años que ingresa a urgencias por cefalea aguda asociada a síntomas neurológicos progresivos con compromiso visual. Presentó tensión arterial elevada, simultagnosia, ataxia óptica y apraxia oculomotora. Los estudios imagenológicos reportaron hemorragia subaracnoidea por trombosis de seno sigmoideo izquierdo, por lo que se inició anticoagulación, antihipertensivo, con adecuada evolución del cuadro clínico. Discusión: a pesar de que el síndrome de Balint es un trastorno poco común, de etiología diversa, con escasos reportes a escala global, el caso comentado concordó con las características descritas en la literatura. El abordaje de la paciente en su atención inicial permitió la sospecha diagnóstica oportuna y la indicación de ayudas diagnósticas imagenológicas pertinentes. Tales ayudas soportaron un manejo temprano y la adecuada evolución y resolución del cuadro, en el contexto de la asociación del síndrome a una trombosis de senos venosos cerebrales (una etiología infrecuente). Conclusión: mediante una historia clínica completa y minuciosa, junto a un adecuado examen neurológico, es posible hacer un acercamiento diagnóstico temprano que permita generar la sospecha del síndrome de Balint y la solicitud temprana de imágenes diagnósticas que orienten en el estudio de su etiología y manejo oportuno, con mejores desenlaces en el paciente.

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COVID-19 and stroke: from the cases to the causes

Frisullo

Scala

Bellavia

et al. 2021

Reviews in the Neurosciences

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During COVID-19 pandemic, a wide variety of stroke typologies have been described in patients affected by SARS-CoV-2. Investigating the case reports of acute stroke in COVID-19 patients, published since the beginning of the pandemic, we tried to trace the pathogenic mechanisms of stroke during SARS-CoV-2 infection. We conducted a systematic review analyzing demographic data, cerebrovascular risk factors, NIHSS score, vascular territory involvement and laboratory findings of 168 patients described in 89 studies, from a pool of 1243 records. Based on our results, we have identified different stroke profiles: (1) cerebral large vessel disease (CLVD) profile with a low disability, simultaneous onset of COVID-19 and stroke symptoms, good outcome and low serum levels of D-dimer and CRP; (2) intracranial bleeding (IB) profile with high disability, poor outcome and low levels of serum markers of inflammation and coagulopathy; (3) CLVD profile with a short time-lapse between COVID-19 symptoms and stroke onset, high neurological disability and very high systemic inflammatory markers; (4) multiple thrombo-embolic disease (MTED) profile with older patients, many comorbidities, disabling stroke, poor outcome, evident alteration of coagulation tests and high serum levels of both D-dimer and CRP. We therefore summarized these different profiles in a spectrum similar to that of visible light, where the violet–blue band included IB and CSVD with low inflammation and prothrombotic activity, the green–yellow band included CLVD with high inflammation and moderate prothrombotic activity and the orange–red band for MTED with moderate-high levels of inflammation and very high prothrombotic activity.

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Balint-Holmes syndrome due to stroke following SARS-CoV-2 infection: a single-case report

Cited by 5 publications

References 5 publications

SARS-CoV-2 Impairs Vision

SARS-CoV-2 Impairs Vision

Síndrome de Balint y trombosis de senos venosos cerebrales: reporte de caso

COVID-19 and stroke: from the cases to the causes

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