To present an atypical case of Balint syndrome associated with right-sided occipital-temporal infarcts.

Balint syndrome is a rare neurological disorder typically resulting from bilateral parietal-occipital lesions and is characterised by the triad of optic ataxia, oculomotor apraxia, and simultanagnosia. Lesions in other regions, including the prefrontal cortex, frontal eye fields, and temporo-occipital areas, may produce similar features. Due to its rarity and overlap with hemineglect or conversion disorders, Balint syndrome is often under-recognised and misdiagnosed.

A 73-year-old hypertensive male smoker presented with left-sided hemiparesis and dizziness for less than 24 hours’ duration. Examination revealed left hemiparesis, intact cranial nerves, preserved sensation, and normal visual acuity. Visuomotor testing demonstrated left-sided optic ataxia, oculomotor apraxia, and simultanagnosia, with intact cognition and language. MRI revealed acute non-hemorrhagic infarcts in the cortical-subcortical region of the right occipital lobe, extending to the posteromedial temporal region, with chronic lacunar infarcts in the pons and cerebellum. MR angiography showed multifocal narrowing of the bilateral M2 segments and the left M1 segment, suggesting a possible vasculopathic mechanism. The patient received intravenous thrombolysis, along with edaravone 30mg twice daily for 14 days for neuroprotection, followed by secondary prevention with dual antiplatelet therapy, atorvastatin, amlodipine, and telmisartan. Comprehensive neurorehabilitation focusing on visuospatial and hand-eye coordination training led to gradual improvement in both motor and visuospatial functions over three months.

This case illustrates that unilateral right occipito-temporal lesions may give rise to the characteristic triad of Balint’s syndrome. Progressive forms are often linked to degenerative disease; sudden-onset cases usually follow stroke, as in this patient. Recognition of such atypical presentations is crucial for timely diagnosis and targeted rehabilitation. However, their rarity limits treatment evidence, underscoring the need for further research to enhance patient care.