Gerstmann syndrome: causes, symptoms and treatment
At the beginning of the last century, Josef Gerstmann encountered a patient who, after a brain injury, was unable to name the fingers of 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 happens after an injury of the parietal lobes. We will describe what your symptoms are, where the injury is located and for what causes it may occur.
- Related article: "The 15 most frequent neurological disorders"
Symptoms of Gerstmann syndrome
When we talk about Gerstmann's original patient, we always mention the four classic symptoms: digital agnosia, agraphia, acalculia and problems of laterality.
If these four cardinal points occur simultaneously in a patient, we say that he suffers from Gerstmann syndrome.
1. Digital agnosia
It is a form of asomatognosia, that is, inability to recognize parts of one's own body . This symptom can affect any of the sides of the body depending on which cerebral hemisphere is affected. Interestingly, the inability to recognize the fingers is closely related to the presence of dyscalculia. Those children who, due to injury or malformation, are unable to recognize their own fingers, have much more difficulty learning to calculate.
2. Agraphia
The patient with Gerstmann syndrome is unable to communicate in writing . Agraphy can occur for two different reasons: either an injury that causes linguistic deficits or an injury where the linguistic ability is good, 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 disorders 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 the difficulties in performing arithmetic head operations . Patients with Gerstmann syndrome have difficulties with even the simplest sums and subtractions. It remains to elucidate exactly at what point of the arithmetic operations the disability occurs. Perhaps it is in the retention of numbers in consciousness, as a kind of working memory for arithmetic operations.
4. Problems of laterality
Gerstmann's patient was completely unable to differentiate left from right . This is not 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 responds randomly to the tests that are done in this regard.
To this classic tetralogy other symptoms are added 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 over the course of the century it has become more and more relevant in the case descriptions.
5. Aphasia
The inability to articulate the language can be observed in many patients with Gerstmann syndrome , indicating that more than an affectation of concrete capacities, what could be affected in fact is the symbolic thought. Moreover, it could even be that the inability to understand abstract concepts explained that patients do not know what to answer when asked where the right is or which is the index finger, confusing digital agnosia with receptive aphasia.
Causes of this syndrome
The syndrome occurs due to injury in the left parietal region of the brain, specifically the angular gyrus . The parietal is the one that is in charge of the motricity and sensitivity, the spatial, the calculus and part of the language. It is normal, then, that an injury somewhere in the parietal lobe, due to geographic and functional proximity, affects this entire group.
It is common for regions close to each other to perform similar functions or to complement each other, as if they had each specialized in a particular aspect of a more general function. For example, the motor and sensitivity are closely related and the one is next to the other. Thus, a lesion in the motor can also alter the sensitivity and vice versa.This is the reason why an apparently focal lesion can affect an entire subsystem of related components.
The reasons why someone could suffer damage to the parietal lobe are multiple . Cranioencephalic traumas, through the own stroke or the edema that is generated later, brain tumors or even cerebrovascular accidents are common causes of this syndrome. It is very common to find people who have lost the blood supply to this area of the brain, losing the neurons responsible for these functions.
Treatment
The 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 can not be rehabilitated and relearn all those skills you've lost. Depending on the injury, the severity of the injury and the age of the individual, the prognosis is different.
To get an idea, we must think that the brain is very plastic and has the ability to reorganize 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 without cost. The younger the brain, the greater the capacity to adapt.
With the progressive training it is possible to restore the functions. It will not always be possible to return to the operation prior to the syndrome, especially if the affected area is very large or the lesions are deep, but the disability is ruled out if cognitive rehabilitation is followed exhaustively.
