Gerstmann syndrome is a neuropsychiatric disorder that is characterized by a constellation of symptoms that suggests the presence of a lesion usually near the temporal and parietal lobe junction. Damage to the inferior parietal lobule of the dominant hemisphere results in Gerstmann syndrome.

SYMPTOMS

Gerstmann syndrome is characterized by four primary symptoms:

1. Dysgraphia/agraphia: deficiency in the ability to write
2. Dyscalculia/acalculia: difficulty in learning or comprehending mathematics.
3. Finger agnosia: inability to distinguish the fingers on the hand
4. Left-right disorientation

CAUSES

This disorder is often associated with brain lesions in the dominant (usually left) hemisphere including the angular and supramarginal gyri (Brodmann area 39 and 40 respectively) near the temporal and parietal lobe junction. There is significant debate in the scientific literature as to whether Gerstmann syndrome truly represents a unified, theoretically motivated syndrome. Thus its diagnostic utility has been questioned by neurologists and neuropsychologists alike. The angular gyrus is generally involved in translating visual patterns of letters and words into meaningful information, such as is done while reading.

In adults, the syndrome may occur after a stroke or in association with damage to the inferior parietal lobule of the dominant (left) side. In addition to exhibiting the above symptoms, many adults also experience aphasia, which is a difficulty in expressing oneself when speaking, in understanding speech, or in reading and writing.

DIAGNOSIS

Diagnosis may be clinical if associated with dementia and other etiologies. In cases caused by stroke, MRI will show a corresponding stroke in the inferior parietal lobule. In the acute stage, this will be bright (restricted diffusion) on the DWI sequence and dark at the corresponding area on the ADC sequence.

TREATMENT

There is no cure for Gerstmann syndrome. Treatment is symptomatic and supportive. Occupational and speech therapies may help diminish the dysgraphia and apraxia. In addition, calculators and word processors may help school children cope with the symptoms of the disorder.