optic ataxia

optic ataxia, condition in which some or all aspects of visual guidance over reaching with the hand and arm are lost. Optic ataxia is broadly characterized by an inaccuracy of visually guided arm movements. In reaching for an object, a person with severe optic ataxia may seem to grope in the dark, extending a flattened hand hesitantly until chance contact allows the object to be retrieved by touch. Optic ataxia occurs as a result of damage to specific regions of the brain.

History of optic ataxia

The term optic ataxia (optische Ataxie in the original German) was coined by Hungarian physician Rezso (Rudolf) Bálint in his 1909 report of a man with lesions of the posterior parietal lobe on both sides of the brain. Optic ataxia was one of several symptoms of a condition that later became known as Bálint syndrome. Among the symptoms that characterize the syndrome are a restriction of visual attention to single objects and a paucity of spontaneous eye movements. Bálint noted inaccurate reaching of the man’s right hand. The patient commented that his right hand was clumsy; for instance, he often found himself lighting a cigarette at its middle instead of at its end. Those errors could not be ascribed to any general visual impairment, as his left-hand reaching was accurate. Similarly, he could make coordinated right-hand reaches with his eyes closed to different parts of his body, ruling out a right-sided movement disorder. Thus, the problem was neither visual nor motor but visuomotor, emerging only for movements made under visual guidance. That confluence is well captured by Bálint’s term, which implies a movement disorder (ataxia) that is specifically visual (optic).

Presentation and diagnosis

When optic ataxia is severe, misreaching is obvious to the patient and to others. However, specialized testing may be required to confirm the symptom or to diagnose its subtle forms. Typically, the examiner will present an object, such as a pen, to the left or right side for grasping by each hand. That will be done both when the patient can look at the pen directly and when the patient must look straight ahead so that it falls outside of central vision. Misreaching most often emerges only in the latter case, with accurate reaching under direct viewing. It may also be specific to certain combinations of the target side and hand. Two main patterns of misreaching are typical: a field effect, whereby large errors are made with either hand on the side of space opposite that of the damaged brain area; and a hand effect, whereby the hand anatomically opposite to the brain damage misreaches for targets on either side. The diagnosis is confirmed by showing that the errors are not due to other disorders that affect vision or movement.

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A range of additional impairments may be present in optic ataxia, including failure to rotate or pre-shape the hand appropriately for grasping, inability to correct ongoing movements for changes in target position, and insensitivity to obstacles in the reach space. Inaccurate visuomotor guidance may also be observed for the foot by asking the patient to touch a target with a toe.

Neuroanatomy

Patients with optic ataxia may have extensive brain damage, especially if symptoms manifest as part of Bálint syndrome. Bálint’s original patient, for instance, had lesions in the posterior parietal lobe and extending into the occipital lobe on both sides of the brain. However, lesions restricted to one side of the brain are the more usual cause of isolated optic ataxia. By studying patterns across patients, it may be possible to discern whether there is any specific subregion that is invariably affected. The key areas of involvement have been found to be in and around the intraparietal sulcus and at the junction between the occipital and parietal lobes. Those brain areas presumably are critical for the visual guidance of reaching in humans.