The requisite visual modalities for the reflex blink to visual threat have not been thoroughly studied. We identified five patients with different focal cerebral lesions documented on computerized tomography scan who had abnormal blink-to-threat reflexes. One had a homonymous hemianopia secondary to posterior cerebral artery occlusion; another had a unilateral parietal neglect; and a third had a frontal neglect. They did not blink in response to visual stimuli contralateral to their lesion. A cortically blind patient and one with Balint's syndrome did not have a blink response. Observation of these and other similar patients and animals previously reported suggests that the blink-to-threat reflex is cortically mediated and requires intact primary visual cortex as well as higher order mechanisms for visual attention mediated in the inferior parietal lobule and frontal eye fields.