Gerstmann Syndrome

Gerstmann Syndrome is a neurological disorder that is characterized by a seriees of symptoms that suggests the presence of a lesion in your brain. It is named after Jewish Austrian-born American neurologist Josef Gerstmann (1887-1969)[1][2][3].

However, there is (still) significant debate in the scientific literature as to whether Gerstmann syndrome truly represents a unified, theoretically motivated syndrome.

Gerstmann Syndrome is characterized by four primary symptoms, collectively referred to as a tetrad (a triad plus one):
[1] Deficiency in the ability to write (dysgraphia or agraphia);
[2] Difficulty in learning or comprehending mathematics (dyscalculia or acalculia);
[3] Inability to distinguish the fingers on the hand (finger agnosia);
[4] Left-right disorientation

[5] In addition to exhibiting the above symptoms, many adults also experience difficulty in expressing oneself when speaking, in understanding speech, or in reading and writing (dysphasia or aphasia), which makes it effectively a pentad of symptoms.

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. 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. There are few reports of the syndrome, sometimes called Developmental Gerstmann Syndrome but the cause is not known. Generally, children with the disorder exhibit poor handwriting and spelling skills, and difficulty with math functions, including adding, subtracting, multiplying, and dividing. An inability to differentiate right from left and to discriminate among individual fingers may also be apparent.

[6] In addition to the four primary symptoms, many children also have constructional apraxia, an inability to copy simple drawings, which makes it effectively a hexad of symptoms. Frequently, there is also an impairment in reading.

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. In adults, many of the symptoms diminish over time. Although it has been suggested that a similar diminishing of symptoms occurs in children as well, it appears more likely that most do not overcome their deficits, but instead simply learn to adjust.

[1] Gerstmann: Fingeragnosie. Eine umschriebene Störung der Orien-tierung am eigenen Körper in Wiener Klinischen Wochenschrift - 1924
[2] Gerstmann: Fingeragnosie und isolierte Agraphie; ein neues Syndrom in Zeitschrift für die gesamte Neurologie und Psychiatrie - 1927
[3] Gerstmann: Über ein noch nicht beschriebenes Reflexphänomen bei einer Erkrankung des zerebellaren systems in Wiener Medizinische Wochenschrift - 1928