Gerstmann syndrome

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Introduction

Not to be confused with Gerstmann-Straussler-Scheinker disease.

Etiology

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

* 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
    • name finger
    • match the position of fingers on one hand with the fingers on the other hand while the eyes are closed
    • identify the number of fingers between 2 fingers touched by the examiner with the eyes closed
  • 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

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

  1. Cummings, Hospital Practice, May 1993, pg 56-68
  2. 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
  3. NINDS Gerstmann's Syndrome Information Page https://www.ninds.nih.gov/disorders/all-disorders/gerstmanns-syndrome-information-page

Patient information

Gerstmann syndrome patient information