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 the fingers on his hand, or to recognize them if you want. Moved by the interest of this curious symptom, he found a constellation of symptoms that accompanied this phenomenon.

Let's see below the Gerstmann syndrome, a clinical picture that occurs after a lesion of the parietal lobes. We will describe what its symptoms are, where the injury is and why it can occur.

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Gerstmann syndrome symptoms

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 are present at the same time in a patient, we say that he suffers from Gerstmann syndrome.

1. Digital agnosia

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

2. Agrafia

Gerstmann syndrome patient is unable to communicate in writing. Agraphia can occur for two different reasons: either due to an injury that causes linguistic deficits or because of an injury where the linguistic ability is fine, but the motor skills are affected.

In the case of Gerstmann syndrome it is not clear what the reason for this is. Although some patients also present other language alterations such as inability to read or aphasias that could be related, we also know that a common denominator in the syndrome is the inability to manipulate images mentally. Both hypotheses remain in the air.

3. Dyscalculia

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

4. Laterality problems

Gerstmann's patient was completely unable to differentiate left from right. This is not the crossed laterality, where both directions are confused, but the loss of the notion of laterality. For this person left and right do not exist and he responds randomly to the tests that are made in this regard.

To this classic tetralogy are added other symptoms that 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 present these four key points. Many of the patients show a fifth symptom not included in the tetralogy, but which throughout the century has gained more and more relevance in the case descriptions.

5. Aphasia

The inability to articulate language can be seen in many patients with Gerstmann syndrome., indicating that more than an affectation of concrete capacities, what could actually be affected is symbolic thinking. Furthermore, it could even be that the inability to understand abstract concepts explains why patients do not know what respond when asked where is the right or what is the index finger, confusing digital agnosia with aphasia responsive.

Causes of this syndrome

The syndrome occurs due to injury to the left parietal region of the brain, specifically the angular gyrus. The parietal is who is responsible for motor skills and sensitivity, spatial, calculation and part of the language. It is normal, then, that an injury somewhere in the parietal lobe, due to geographical and functional proximity, affects this entire group.

It is common for regions close to each other to carry out similar functions or to complement each other. with each other, as if each had specialized in a specific aspect of a more general. For example, motor skills and sensitivity are closely related and one is next to the other. Thus, an injury to motor skills can also alter sensitivity and vice versa. This is the reason why an apparently focal lesion can affect a whole subsystem of interrelated components.

The reasons why someone could suffer damage to the parietal lobe are multiple. Head trauma, through the blow itself or the edema that is generated later, brain tumors or even strokes are common causes of this syndrome. It is very common to find people who have lost blood supply to this area of ​​the brain, losing the neurons in charge of these functions.

Treatment

Treatment of Gerstmann syndrome is symptomatic. There is nothing that can be done to automatically restore the damage, but this does not mean that the individual cannot be rehabilitated. and relearn all those skills you have lost. Depending on the injury, its severity, and the individual's age, the prognosis is different.

To get an idea, we must think that the brain is very plastic and has the ability to reorganize itself to assume the functions that have been lost. As if the workers of a company assumed the responsibilities of an entire department that has just been fired, but at no cost. The younger the brain, the greater the ability to adapt.

With progressive training it is possible to restore functions. It will not always be possible to return to pre-syndrome function, especially if the affected area is very large or the injuries are deep, but disability is ruled out if cognitive rehabilitation is followed in a exhaustive.