Transient Gerstmann syndrome as manifestation of stroke: Case report and brief literature review

Abstract

Gerstmann Syndrome (GS) is a rare neurological condition described as a group of cognitive changes corresponding to a tetrad of symptoms comprising agraphia, acalculia, right-left disorientation and finger agnosia. It is known that some specific brain lesions may lead to such findings, particularly when there is impairment of the angular gyrus and adjacent structures. In addition, the possibility of disconnection syndrome should be considered in some cases. The purpose of this article is to report a case of a young, cardiac patient, non-adherent to treatment, who presented with a stroke in which transient clinical symptoms were compatible with the tetrad of GS. The case report is followed by a discussion and brief review of the relevant literature.

Frontal Lobe: Functional Neuroanatomy of Its Circuitry and Related Disconnection Syndromes

“…In recent years, publications have reported clinical cases with neuropsychiatric manifestations hitherto attributed to certain lesions to specific cortical topographies. However, complementary investigation using neuroimaging has disclosed changes in other brain sites [15,16]. A number of authors have stated that this phenomenon can be explained by disruption of the subcortical associative pathways involved in the neuronal network integrating the higher cortical functions [1].…”

“…Thus, it is important to recognize the concept that lesions external to the frontal lobe can lead to the typical manifestations of "frontal syndromes", and also to understand that damage to the frontal lobe or in its vicinity can cause abnormalities classically described as being secondary to more posterior brain lesions, a mechanism involved in the physiopathogeny of the disconnection syndromes [16]. For didactic purposes and practical applicability, several cases illustrating these clinical situations will be reported in the ensuing subsection.…”

“…Illustrative case 9: Gerstmann syndrome secondary to fronto-insular damage Gerstmann syndrome (GS) is a neurological condition characterized by a group of cognitive alterations making up the tetrad of acalculia, agraphia, right-left disorientation, and finger agnosia. Classically, this syndrome was attributed to lesions involving the angular and supramarginal gyri of the dominant hemisphere; however, its localization value has been questioned in the decades following the first publication [16]. Recently, a number of cases have been reported suggesting that disconnectivity may be the physiopathogenic basis of GS.…”

“…Recently, a number of cases have been reported suggesting that disconnectivity may be the physiopathogenic basis of GS. Some of these cases were secondary to lesions involving the frontal lobe and its association pathways [16,[40][41][42].…”

“…Figure 11. Cranial computed tomography, brain MRI (FLAIR-weighted), and brain diffusion MRi (DWI) showing, respectively, hypodense area in the left inferior frontal gyrus, hypersignal in the left anterior and posterior insular cortex, and restricted diffusion in the cortical region of the left insular topography, with sparing of the left angular and supramarginal gyri in a patient with transient Gerstmann syndrome [16].…”