Pediatric Balint’s syndrome variant: A possible diagnosis in children

Balint’s syndrome is well described in adults, but not in children. It is caused by bilateral posterior parietal lobe damage and comprises a triad of simultanagnosia (inability to simultaneously see more than a small number of items), optic ataxia (impaired visual guidance of movement of the limbs and body), and apraxia of gaze (inability to volitionally direct gaze despite the requisite motor substrate) often associated with homonymous lower visual field loss. We, here, describe five children (four males, one female; mean age 7.4 years, [range 4−11 years]; birth weight ≤ 2.5 kg; four were born ≤ 36 weeks of gestational age and one at 40 weeks) who presented to the Cerebral Visual Impairment Clinic at a tertiary care center in South India with clinical features remarkably consistent with the above description. In all children neuroimaging showed bilateral parietooccipital gliosis with regional white matter volume loss and focal callosal thinning, consistent with perinatal hypoxic ischemic encephalopathy and possible neonatal hypoglycemia

Uncommon presentation of idiopathic intracranial hypertension

A 51-year-old gentleman, a known hypertensive on medications presented with transient visual disturbance in his left eye. Examination revealed the presence of unilateral optic disc edema. A lumbar puncture revealed elevated opening pressure with normal cerebrospinal fluid biochemical parameters. Neuroimaging showed no evidence for an alternative cause for intracranial hypertension thus confirming the diagnosis of idiopathic intracranial hypertension (IIH). IIH can rarely present with a unilateral papilledema. This emphasizes the need to meticulously examine both optic fundi in all patients with suspected intracranial hypertension. Early diagnosis of this condition can help in the prevention of permanent visual loss. We hereby report the second case of IIH presenting with a unilateral papilledema in Indian literature

Management of Severe Cerebral Venous Sinus Thrombosis Using Mechanical Balloon Assisted Thrombectomy

Background Cerebral venous thrombosis is a devastating condition with, despite optimal medical management, a significant proportion deteriorating due to involvement of the deep venous system, worsening intracranial pressures, and hemorrhage. In this study, we report the characteristics, immediate and long‐term outcomes of mechanical thrombectomy (MT) using a Forgarty balloon catheter among patients with cerebral venous thrombosis. Methods A prospective study conducted at the Christian Medical College, Vellore over 5 years (February 2017–February 2022), wherein patients with cerebral venous thrombosis who had clinical deterioration despite best medical management and requiring MT were included. MT was performed through retrograde venous access through internal jugular veins using a Fogarty balloon. The primary outcome was composite end point of mortality and proportion of patients with favorable clinical response at last follow‐up, defined as a disability score in modified Rankin scale 0–2. Results Among 546 patients treated in our center during the study period, 57(10%), patients required MT. The median age of the study population was 33 years (interquartile range: 17–70 years) with equal gender predilection. Hemorrhagic venous infarction was seen in 28/57 (50%) patients. The mean duration between starting medical treatment and to MT was 43 hours (interquartile range: 5–260 hours) with the most common indication being clinical deterioration (70%). Five patients (9%) required decompressive hemicraniectomy. The mortality at discharge was 5% (n=3), and at last follow‐up visit was 7% (n=4). Younger patients without hemorrhagic venous infarction and non‐involvement of the frontoparietal lobes seem to benefit the most. Favorable functional outcome at discharge (modified Rankin scale 0–2) was seen in 65% which further improved to 77% at 1‐year follow‐up. Conclusion Balloon‐assisted MT is safe and effective in a subset of patients with severe cerebral venous thrombosis, with clinical deterioration despite optimal medical management