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Gerstmann syndrome

Not to be confused with Gerstmann-Straussler-Scheinker disease. Etiology: 1) stroke 2) idiopathic cases in children Pathology: - cortical lesions in the left inferior parietal lobe (LIPL) vs subcortical LIPL lesions that disconnect multifocal cortical areas involved in performing tasks impaired in Gerstmann syndrome [2] Clinical manifestations: 1) acalculia 2) right-left disorientation 3) finger agnosia 4) dysgraphia 5) aphasia* is also often present * Strictly, aphasia is not part of the syndrome Special laboratory: Assessment: 1) test mental arithmetic a) 14 + 23 b) 5 x 13 c) 23 - 8 d) word problems -> What change will I get from a $5 bill if I buy 3 oranges for 60 cents apiece? 2) test right-left orientation a) ask patient to point to parts on his/her own body, then ask the patient to point to the same places on the examiners body as the examiner stands facing the patient b) patients with lesions in the left inferior parietal lobe lack the ability to mentally reverse right to left 3) test finger identification a) name finger b) match the position of fingers on one hand with the fingers on the other hand while the eyes are closed c) identify the number of fingers between 2 fingers touched by the examiner with the eyes closed 4) test dysgraphia a) ask the patient to write a complete sentence b) if the patient cannot write, ask him/her to dictate a sentence c) motor system disorders produce a mechanical agraphia d) Gerstmann syndrome produces an aphasic agraphia 5) test praxis a) pantomime use of a toothbrush, comb, hammer &/or scissors with each hand b) patients with apraxia fail the test altogether or may susbtitute their hand for the object (i.e. placing their finger in their mouth for 'toothbrush') c) apraxia indicates white matter lesions a) deep in the left parietal lobe b) beneath the premotor cortex c) lesions of the corpus callosum Management: 1) treatment is symptomatic & supportive 2) occupational therapy 3) speech therapy 4) computers may useful 5) prognosis a) in adults, many symptoms diminish with time b) most children do not overcome deficits, but learn to adjust

General

learning disorder (learning disability) syndrome

References

  1. Cummings, Hospital Practice, May 1993, pg 56-68
  2. Rusconi E et al. A disconnection account of Gerstmann syndrome: Functional neuroanatomy evidence. Ann Neurol 2009 Nov; 66:654. PMID: 19938150
  3. NINDS Gerstmann's Syndrome Information Page https://www.ninds.nih.gov/disorders/all-disorders/gerstmanns-syndrome-information-page