Gerstmann syndrome causes many symptoms. This article will explore what Gerstmann syndrome is and the problems it can cause, with a focus on finger agnosia.

Gerstmann syndrome

If the parietal lobe of your brain is damaged, this can cause Gerstmann Syndrome.¹

The parietal lobe has many jobs. These include:²

• Your awareness of things around you
• Processing sensations 
• Understanding language
• Your memory

Therefore, if the parietal lobe gets damaged, you may struggle with some or all of the aboabove-listedings.¹ This syndrome should be treated by a neurology team with help from other healthcare professionals to provide the best help possible for treatments with Gerstmann Syndrome.³

Gerstmann syndrome affects people assigned female at birth and people assigned male at birth equally.⁴ There does not appear to be a genetic cause of Gerstmann syndrome, and it can sometimes affect children who do very well at school as well as children who have cognitive difficulties.⁴

Gerstmann syndrome was discovered by a neurologist from Vienna named Dr. Josef Gerstmann.⁴ It was first brought to the attention of the medical community in 1924.⁴

The four main symptoms linked to Gerstmann syndrome are dysgraphia, acalculia, finger agnosia and right-left confusion (these symptoms are discussed later in the article).⁴ If the patient only has these four problems and does not struggle with any other issues, then they are considered to have “pure” Gerstmann Syndrome.⁴ However, it is common for people to have more than just these four difficulties.⁴

Causes of Gerstmann syndrome

Gerstmann syndrome can be caused by several things. These are explored in this section.

Gerstmann syndrome in adults 

Gerstmann Syndrome is caused by damage to the parietal lobe, specifically the left angular gyrus, which is part of your brain that is used for language.¹,²⁰ This can happen in several ways. 

Stroke

A stroke can cause damage to the parietal lobe.⁴ A stroke happens when the blood supply to the brain has been stopped, either due to the blood vessels becoming blocked or because one of the blood vessels that brings oxygen to the brain bursts.⁵ 

If the blood supply to the parietal lobe is affected by a stroke, this can lead to Gerstmann Syndrome.⁴

Brain tumour

A tumor is made when a group of cells begin to make more of themselves in a very fast, uncontrolled way.⁶ These cells become a mass called a tumour.⁶

If a tumor grows at the parietal lobe, it can cause damage, which can lead to the person developing Gerstmann Syndrome.⁴

Injury

If the parietal lobe gets injured, for example, by an accident, carbon monoxide poisoning, alcoholism, or lupus, this damage can mean that the person who was injured will go on to have Gerstmann Syndrome.⁴

Epilepsy

Some epilepsies always affect one half of the brain. This is known as focal epilepsy.⁷

If the affected part of the brain includes the parietal lobe, this can cause Gerstmann syndrome.

Gerstmann syndrome in children

Some children have Gerstmann syndrome even though they have no known brain problems.¹ This is known as Developmental Gerstmann Syndrome, and the reason for this is not known.¹

Symptoms of Gerstmann syndrome

Gerstmann syndrome has many symptoms, and patients with it may have some or all of the symptoms.¹

These symptoms can be severe enough that the patient may not be able to lead a normal life.³

Right-left confusion

People with Gerstmann syndrome can find it very difficult to tell their left from their right.⁴ 

It’s not exactly known why this happens, but one theory is that the body has different ways of processing horizontal (side to side) and vertical (up and down) body awareness.⁸ If this is true, it could explain why patients struggle to tell left from right but not up from down, as the horizontal understanding could be damaged without affecting other spatial senses.⁸ 

Dysgraphia

Dysgraphia is the name used when a person struggles to write or to translate their thoughts into written words.⁹ This is common in Gerstmann Syndrome.⁴ 

Acalculia

People with acalculia struggle to understand numbers or do mathematical calculations.¹⁰ Gerstmann syndrome can cause acalculia.⁴

Aphasia

Aphasia causes people who have it to struggle with communication.¹¹ This can be any form of communication, including spoken, written, by listening, or by reading.¹¹

People with Gerstmann Syndrome can develop Aphasia, though it is less common than the other symptoms.⁴

Constructional apraxia

If someone cannot copy basic drawings, this is called constructional apraxia.¹ Some people with Gerstmann syndrome have this problem.¹

Finger agnosia

People with Gerstmann syndrome often has finger agnosia. When this happens, they cannot recognize fingers either on their own hands or on the hands of someone else.¹² They also cannot point to a finger if someone asks them to or move their fingers if asked to.¹²

Diagnosing finger agnosia

To diagnose finger agnosia, your doctor will ask you to perform certain tasks and ask you questions about your experiences.¹²

• They may point to two of your fingers and ask you to tell them how many fingers are between the two that they selected¹²
• They may also show you a drawing of a hand and ask you to name the finger (e.g., index, middle, ring, little) that they point to¹²
• Another task may be that they gently touch a finger and ask you to move the finger that they just touched to see if you are able to¹²

They may ask you to do these tasks both while you are looking at your hand and then with your hand covered, as people with finger agnosia find these things more difficult when they cannot see their own hand.¹²

Treatment of Gerstmann syndrome

Gerstmann syndrome may be treated by taking care of the cause if this is known.³ This could involve removal of a brain tumor, the removal of the epilepsy focal lesion, the treatment of a hemorrhage, helping the patient with their alcoholism, treating the lupus, or treating the carbon monoxide poisoning.³

Adults with Gerstmann syndrome often notice their symptoms improving over time.

Children with Gerstmann syndrome also tends to find the syndrome less bothersome over time, but this may be because they learn to adapt to the syndrome rather than their condition improving.¹

Symptom management

Sometimes Gerstmann syndrome cannot be treated, but the patient’s healthcare team may be able to help the patient cope with their symptoms.

The patient may receive care from a speech and language therapist who will help the patient to improve their communication skills.¹³

Occupational therapy is often also used to help patients with Gerstmann Syndrome.¹⁴ This service helps people to perform everyday tasks more easily, either via training or by providing equipment to make these tasks easier.¹⁵ People with Gerstmann syndrome often find word processors and calculators can help them with everyday life.¹

Differential diagnosis

Some other conditions have similar symptoms to Gerstmann Syndrome. Your doctors will want to rule these out when they are diagnosing Gerstmann Syndrome.

Disconnection syndrome

In some patients, there may be a disturbance in the connections between different areas in the cerebral cortex¹⁶ (the nerve cells on the outside of the brain).¹⁷ Patients with Disconnection Syndrome can have similar problems to people who have Gerstmann Syndrome.

Posterior cortical atrophy

Posterior cortical atrophy is a form of dementia that can have similar symptoms to Gerstmann Syndrome.¹⁸ It affects a person’s ability to read and recognize things, but it doesn’t affect someone’s memory until quite late.¹⁸

Alzheimer’s disease

Alzheimer’s disease is a form of dementia that can have a negative effect on someone’s memory and thinking ability.¹⁹ These symptoms can be similar to those of a person who has Gerstmann Syndrome..

Summary

Gerstmann syndrome is a serious problem that can have many life-altering symptoms, including finger agnosia.

People with Gerstmann syndrome should be managed by a neurology team and supported by other health professionals to help them manage their symptoms.