Gerstmann syndrome
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Introduction
Not to be confused with Gerstmann-Straussler-Scheinker disease.
Etiology
- stroke
- 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
- acalculia
- right-left disorientation
- finger agnosia
- dysgraphia
- aphasia* is also often present
* Strictly, aphasia is not part of the syndrome
Diagnostic procedures
Assessment:
- test mental arithmetic
- 14 + 23
- 5 x 13
- 23 - 8
- word problems
- What change will I get from a $5 bill if I buy 3 oranges for 60 cents apiece?
- test right-left orientation
- 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
- patients with lesions in the left inferior parietal lobe lack the ability to mentally reverse right to left
- test finger identification
- test dysgraphia
- ask the patient to write a complete sentence
- if the patient cannot write, ask him/her to dictate a sentence
- motor system disorders produce a mechanical agraphia
- Gerstmann syndrome produces an aphasic agraphia
- test praxis
- pantomime use of a toothbrush, comb, hammer &/or scissors with each hand
- 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')
- apraxia indicates white matter lesions
- deep in the left parietal lobe
- beneath the premotor cortex
- lesions of the corpus callosum
Management
- treatment is symptomatic & supportive
- occupational therapy
- speech therapy
- computers may useful
- prognosis
- in adults, many symptoms diminish with time
- most children do not overcome deficits, but learn to adjust
More general terms
References
- ↑ Cummings, Hospital Practice, May 1993, pg 56-68
- ↑ 2.0 2.1 Rusconi E et al. A disconnection account of Gerstmann syndrome: Functional neuroanatomy evidence. Ann Neurol 2009 Nov; 66:654. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19938150
- ↑ NINDS Gerstmann's Syndrome Information Page https://www.ninds.nih.gov/disorders/all-disorders/gerstmanns-syndrome-information-page