Simultanagnosia
Simultanagnosia
Simultanagnosia, sometimes referred to as simultagnosia, is a distinctive neurological disorder causing an individual to perceive only a single object at one time, even when presented with multiple items within their field of vision.
Overview
Originating as a part of Bálint's syndrome, simultanagnosia is a significant component alongside optic ataxia and optic apraxia. This syndrome represents a group of severe neuropsychological impairments connected to visuospatial processing. Wolpert, in 1924, introduced the term "simultanagnosia" to outline a condition where a person could notice individual elements of an intricate visual but couldn't understand the image's broader context.
Classification
The disorder is primarily classified into two categories based on the severity and area of the brain affected:
Dorsal Simultanagnosia
In cases of dorsal simultanagnosia, the impairment results from bilateral lesions at the conjunction of the parietal and occipital lobes. This leads to the perception of a sole object without realizing the presence of surrounding stimuli. Often, moving objects become harder to discern.
Ventral Simultanagnosia
Originating from damage to the left inferior occipito-temporal junction, ventral simultanagnosia allows patients to recognize multiple items simultaneously. However, their recognition remains piecemeal, restricting them to understanding only one object at a time.
Symptoms
Those with simultanagnosia face a narrowed spatial window of visual attention, leading them to perceive just one object in multi-object scenes. Often, one stationary object might spontaneously disappear from sight as they recognize another object.
A noted phenomenon in these patients is "local capture", where they exclusively identify the local components of stimuli consisting of both local and global attributes. Yet, some studies suggest that there can be implicit processing of the global structure under certain conditions.
Diagnosis
While no quantitative diagnostic methods exist currently for simultanagnosia, clinicians typically use complex visual displays, like the "Boston Cookie Theft" picture or the "Telegraph Boy" picture, to evaluate the symptoms. Patients usually adopt a fragmented approach, mentioning isolated items rather than understanding the broader narrative of the picture.
Causes
The primary cause of simultanagnosia is bilateral lesions between the parietal and occipital lobes, which might occur due to stroke or traumatic brain injury. Degenerative disorders could also lead to this condition. For instance, some patients with progressive dementia might develop simultanagnosic symptoms alongside other syndromes.
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Contributors: Prab R. Tumpati, MD