Gerstmann syndrome: causes, symptoms and treatment

At the beginning of the last century, Josef Gerstmann came across a patient who, after a brain injury, was unable to name which fingers were, Or to recognize them if you want. Moved by the interest shown in this curious symptom, he discovered a constellation of symptoms that accompanied this phenomenon.

Let’s see below the Gerstmann syndrome, A clinical picture that occurs after injury to the parietal lobes. We will describe what your symptoms are, where the injury is, and what may be causing it.

    Symptoms of Gerstmann syndrome

    When we talk about Gerstmann’s original patient, we always mention the four classic symptoms: digital agnosia, agraphia, acalculia, and laterality problems.

    If these four cardinal points occur simultaneously in a patient, he is said to be suffering from Gerstmann syndrome.

    1. Digital agnosia

    It is a form of asomatognosia, that is, an inability to recognize parts of the body itself. This symptom can affect either side of the body depending on which cerebral hemisphere is affected. Interestingly, the inability to recognize fingers is closely related to the presence of dyscalculia. Children who are unable to recognize their own fingers due to injury or deformity have a much harder time learning to calculate.

    2. Agrafia

    The patient with Gerstmann syndrome is unable to communicate in writing. Spelling can occur for two different reasons: either from an injury that causes language deficits, or from an injury where language skills are good but motor skills are affected.

    In the case of Gerstmann syndrome, it is not known what the reason is. While some patients also present with other language disorders such as the inability to read or aphasias which may be related, we also know that a common denominator of the syndrome is the inability to manipulate images mentally. The two hypotheses remain in abeyance.

    3. Dyscalculia

    This is the name given to the difficulties in performing arithmetic operations on the head. Patients with Gerstmann syndrome have difficulty even with the simplest sums and subtractions. It remains to be elucidated exactly at what stage of arithmetic operations the incapacity occurs. Perhaps it is in the retention of numbers in consciousness, as a kind of working memory for arithmetic operations.

    4. Laterality problems

    Gerstmann’s patient was completely unable to differentiate left to right. It is not a question of transversality, where the two senses are confused, but of the loss of the notion of laterality. For this person, left and right do not exist and responds at random to the tests that are carried out in this regard.

    In addition to this classic tetralogy, other symptoms may or may not be present depending on the patient. The lesions in each case are unique and will result in a different clinical picture, although all (or almost all) will have these four key points. Many patients present with a fifth symptom not included in the tetralogy, but which over the century has become increasingly relevant in case descriptions.

    5. Aphasia

    Inability to articulate language can be seen in many patients with Gerstmann syndrome, Indicating that more than an assignment of concrete abilities, what could be affected in reality is symbolic thinking. Moreover, it could even be that the inability to understand abstract concepts explains why patients do not know what to answer when asked where the right is or what the index finger is, confusing digital agnosia with receptive aphasia.

    Causes of this syndrome

    The syndrome passes through a lesion of the left parietal region of the brain, in particular the angular gyrus. The parietal is responsible for motor skills and sensitivity, space, calculation and part of language. It is therefore normal that a lesion somewhere in the parietal lobe, due to the geographical and also functional proximity, affects this whole group.

    It is common for regions close to each other to perform similar functions or complement each other, as if each had specialized in a particular aspect of a more general function. For example, motor skills and sensitivity are closely related and one is close to the other. Thus, a motor injury can also impair sensitivity and vice versa. Therefore, an apparently focal lesion can affect an entire subsystem of interrelated components.

    There are many reasons why someone could damage the parietal lobe. Traumatic brain injuries, the stroke itself or the edema that occurs afterwards, brain tumors or even stroke are common causes of this syndrome. It is very common to find people who have lost their blood supply to this area of ​​the brain, losing the neurons responsible for these functions.


    Treatment of Gerstmann syndrome is symptomatic. There is nothing that can be done to automatically restore the evil, but that does not mean that the individual cannot rehabilitate himself. and relearn all those skills he lost. Depending on the injury, the severity of it and the age of the individual, the prognosis is different.

    To get an idea, you have to think that the brain is very plastic and has the ability to reorganize itself to take on functions that have been lost. As if the workers of a company were assuming the responsibilities of a whole service that had just been laid off, but at no cost. The younger the brain, the greater the capacity to adapt.

    With progressive training, it is possible to restore functions. It will not always be possible to return to functioning before the syndrome, especially if the affected area is very large or if the wounds are deep, but disability is excluded if cognitive rehabilitation is followed thoroughly.

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