600 Section - From Overlooked Diagnosis to Functional Recovery: Complete Balint Syndrome Following Chimeric Antigen Receptor T-Cell Therapy

Balint syndrome is a rare higher-order visual disorder caused by bilateral parieto-occipital involvement and characterized by simultanagnosia, optic ataxia, and ocular apraxia. The syndrome is under-recognized due to a mismatch between neuroimaging findings and real-world visual performance. Complete presentations involving the full triad are exceptionally uncommon, and to date, Balint syndrome following CAR-T–related neurotoxicity has not been described in the medical literature.

Case Description:

We present the case of a 65-year-old woman with diffuse large B-cell lymphoma treated with CAR-T therapy. Following treatment, she developed bilateral parieto-temporal brain damage with severe visual and functional limitations, leading to inpatient rehabilitation. Despite extensive neurological and neuroimaging evaluations and unremarkable ophthalmological findings, no diagnosis was initially established.

Discussions:

Occupational therapy (OT) assessment revealed severe impairments in basic and instrumental activities of daily living, impaired spatial orientation, and a need for continuous assistance (FIM score = 62/126). Performance-based observation identified the full triad consistent with complete Balint syndrome, alongside attention and memory difficulties, while other metacognitive abilities were preserved.
Based on these findings, targeted intervention was initiated.
OT-led neuro-visual rehabilitation focused on functional performance and integrated visual scanning, eye–hand coordination, spatial processing, repetitive task practice, compensatory strategies, and psychoeducation to support safety and independence. Guided practice between sessions supported carryover.
Functional improvement was demonstrated by an increase in FIM score to 104/126, transition from continuous assistance to independent performance in basic activities of daily living, independent wayfinding across familiar and novel settings, improved functional eye–hand coordination during daily tasks, and independent use of basic smartphone functions. Performance in instrumental activities of daily living improved but continued to require assistance.

Conclusions:

This case underscores the critical role of occupational therapy in identifying and rehabilitating under-recognized neuro-visual syndromes through function-based assessment and targeted neuro-visual intervention when conventional evaluations fail to explain everyday disability.