Journal List > Dement Neurocogn Disord > v.12(4) > 1120812

Dement Neurocogn Disord. 2013 Dec;12(4):114-118. Korean.
Published online Dec 31, 2013.  https://doi.org/10.12779/dnd.2013.12.4.114
© 2013 Korean Dementia Association
Clinical Progress of Gerstmann's Syndrome with Left Frontal Lobe Lesion: Two Cases
Hyemi Lee, M.S.,* Heung-Seok Park, M.S.,* Minsu Kim, M.D.,* Yejin Lee, B.S.,* Juhee Chin, Ph.D., and Yun-Hee Kim, M.D.*
*Department of Physical and Rehabilitation Medicine, Stroke and Cerebrovascular Center, Samsung Medical Center, Sunkyunkwan University School of Medicine, Seoul, Korea.
Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address for correspondence: Yun-Hee Kim, M.D. Department of Physical and Rehabilitation Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-2824, Fax: +82-2-3410-0388, Email: yun1225.kim@samsung.com Address for correspondence: Juhee Chin, Ph.D. Department of Neurology, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-2730, Fax: +82-2-3410-2759, Email: juhee.chin@samsung.com
Received Dec 01, 2013; Revised Dec 12, 2013; Accepted Dec 12, 2013.

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Abstract

Gerstmann's syndrome, assigned to a lesion of the dominant parietal lobe, is a neurological disorder characterized by acalculia, agraphia, right-left disorientation and finger agnosia. Some studies report that these symptoms are also shown in other brain lesions. We report two patients who presented with this tetrad of symptoms in initial assessment. Their Brain MRI images both showed lesion of left frontal lobe. Over time, these symptoms became better but some still remained in last assessment. Accordingly, we suggest that a left frontal lesion cause Gerstmann's syndrome.

Keywords: Gerstmann's syndrome; Left frontal lobe; Left parietal lobe

Figures


Fig. 1
Brain MRI of a 51 years old male. Brain MRI showed hemorrhagic transformation after acute left MCA infarction involved in left middle frontal gyrus, inferior frontal gyrus and basal ganglia. (A) Diffuse weighted image. (B) T2 FLAIR.
Click for larger image


Fig. 2
Brain MRI of a 29 years old female. Brain MRI showed an inflitrative glioma involved in left frontal lobe white matter, inferior frontal gyrus, pars opercularis, pars triangularis and insula. And there is hemorrage in left basal ganglia and subcortical area.
Click for larger image

References
1. Gerstmann J. Syndrome of finger agnosia, disorientation for right and left, agraphia and acalculia. Arch Neurol Psychiatry 1940;44:398–407.
2. Tohgi H, Saitoh K, Takahashi S, Takahashi H, Utsugisawa K, Yonezawa H, et al. Agraphia and acalculia after a left prefrontal (F1, F2) infarction. J Neurol Neurosurg Psychiatry 1995;58:629–632.
3. Ando Y, Sawada M, Morita M, Kawamura M, Nakano I. Incomplete Gerstmann syndrome with a cerebral infarct in the left middle frontal gyrus. Rinsho Shinkeigaku 2009;49:560–565.
4. Kang HS, Kim SH, Kim YJ, Han SH. A Case of Gerstmann's Syndrome due to Left Frontal Operculuar. J Korean Dement Assoc 2011;10:137–139.
5. Sinanović O, Mrkonjić Z, Zukić S, Vidović M, Imamović K. Post-stroke language disorders. Acta Clin Croat 2011;50:79–94.
6. Dehaene S, Cohen L. Cerebral pathways for calculation: double dissociation between rote verbal and quantitative knowledge of arithmetic. Cortex 1997;33:219–250.
7. Rusconi E, Pinel P, Dehaene S, Kleinschmidt A. The enigma of Gerstmann's syndrome revisited: a telling tale of the vicissitudes of neuropsychology. Brain 2010;133:320–332.
8. Benton AL. Gerstmann's syndrome. Arch Neurol 1992;49:445–447.
9. Rusconi E, Pinel P, Eger E, LeBihan D, Thirion B, Dehaene S, et al. A disconnection account of gerstmann syndrome: functional neuroanatomy evidence. Ann Neurol 2009;66:654–662.
10. Lucchelli F, De Renzi E. Primary dyscalculia after a medial frontal lesion of the left hemisphere. J Neurol Neurosurg Psychiatry 1993;56:304–307.
11. Keller C, Meister IG. Agraphia caused by an infarction in Exner's area. J Clin Neurosci 2013;21
12. Ogura K, Fujii T, Suzuki K, Mori E. Pure agraphia in Romaji after left inferior frontal gyrus infarction: a case of selective deficit in syllable-to-grapheme conversion in Japanese. Brain Lang 2013;127:1–5.