Between the Borders: Balint Syndrome as a Rare Manifestation of Posterior Circulation Stroke

Balint syndrome is a rare disorder caused by bilateral parieto-occipital damage, most often occurring within the posterior watershed territory between the middle and posterior cerebral arteries. It is characterized by a triad of simultanagnosia, optic ataxia, and oculomotor apraxia, and is often misdiagnosed as delirium, dementia, or cortical blindness, particularly in elderly patients. We report a case of an 82-year-old woman who presented with confusion and visuospatial disorientation following a collapse. Her visual acuity was preserved, but she demonstrated simultanagnosia and oculomotor apraxia. Computed tomography of the brain revealed bilateral occipital watershed infarcts, consistent with Balint syndrome secondary to posterior border-zone infarction. She was managed with secondary stroke prevention and commenced on neurorehabilitation focusing on visuospatial and visuomotor retraining. This case highlights the importance of recognizing Balint syndrome as a rare manifestation of posterior circulation stroke. Awareness of its classic triad facilitates early diagnosis, appropriate neuroimaging correlation, and tailored rehabilitation to optimize patient outcomes.