What Is Gerstmann Syndrome?


Throughout this article, we will explore Gerstmann Syndrome to provide a clear understanding of this  rare neurological disorder. We’ll delve into  what Gerstmann Syndrome is, its  underlying causes, symptoms, diagnostic techniques, and  available treatment options. The goal is to ensure that you are well-informed about this neurological condition, offering valuable insights to aid you in making informed decisions regarding your care. . 

Gerstmann syndrome is a rare neurological disorder  identified by several unique cognitive impairments. The  four key symptoms include  right and left confusion, acalculia (inability to carry out mathematical calculations), agraphia (difficulty writing) and finger agnosia (inability to distinguish different fingers). These symptoms  result from  disruptions in  specific  brain areas, potentially  caused by  health conditions such as strokes, developmental factors, or other brain injuries.1

 Continue reading to gain a deeper understanding of Gerstmann Syndrome, exploring the neurobiological causes, diagnosis through neuropsychological assessment, and effective treatment and management strategies for individuals affected by this complex neurological condition.


Definition of Gerstmann Syndrome

Gerstmann Syndrome is a rare neurological disorder located  in the angular gyrus area of the brain,  identified by the deterioration of specific cognitive or motor regions. It manifests through four key symptoms: right and left confusion, acalculia, agraphia, and finger agnosia. These symptoms may occur individually or together, stemming from disruptions in brain regions responsible for spatial awareness, motor control, and language [1]. Understanding this syndrome is crucial for timely diagnosis and tailored treatment strategies.

Symptoms of Gerstmann Syndrome


A prominent symptom  is agraphia, where  individuals struggle to form written words or sentences, resulting in illegible or distorted handwriting. This arises from disruptions in the language centre and affected motor control.2,3  


Another symptom is Acalculia, involving an inability  to perform mathematical calculations or comprehend  numerical concepts. This results from disruptions in the left angular gyrus, responsible for mathematical reasoning.4  

Finger agnosia

Finger agnosia prevents individuals from identifying their fingers, distinguishing between hands, or recognizing individual fingers. It results from disruptions in the sensorimotor and somatosensory regions, crucial for spatial information and tactile sensations.5   

Right-left confusion 

Individuals with Gerstmann syndrome may experience difficulty distinguishing right from left, leading to confusion and errors in orientation. This arises from disruptions in the parietal lobe, vital for spatial perception.3  

Causes and Neurological Basis

Brain regions involved

The underlying causes of Gerstmann Syndrome stem from disruptions in several different brain regions. The parietal lobe (in particular the angular gyrus) plays a very important role in spatial cognition, any damage to the parietal lobe can result in symptoms such as right-left confusion and finger agnosia.6 

Additionally, language centres such as Wernicke’s area and Broca’s area, which are respectively located in the temporal and frontal lobes of the brain. Any damage to these areas can result in main symptoms of Gerstmann syndrome such as agraphia.7 

Through understanding the involvement of the specific brain regions involved in Gerstmann syndrome, we can provide an insight into the connections between spatial functions, language and cognition amongst individuals with Gerstmann Syndrome. 

Potential causes: brain injury, stroke, developmental factors

The development of Gerstmann Syndrome can be attributed to a wide range of potential causes, such as brain injuries, stroke and developmental factors. Any brain injuries (such as tumours or trauma) can severely disrupt the functioning of several brain regions which are responsible for the symptoms associated with Gerstmann syndrome. 

During brain development, various developmental factors could potentially lead to atypical neural connections which also contribute to the motor and cognitive impairments of Gerstmann Syndrome. 

An additional cause of Gerstmann syndrome are strokes, when these strokes affect specific regions of the brain it can result in the symptoms of this syndrome. This is due to a compromised blood supply as a result of the stroke causing damage to these regions of the brain.8 This range of potential causes highlights the complex connection between brain function, structure and the symptoms of Gerstmann Syndrome. 


Neuropsychological assessment

Diagnosing Gerstmann Syndrome involves a comprehensive neuropsychological assessment. Specialists evaluate spatial perception, language skills, motor functions, and cognitive abilities through tasks and tests. This helps identify specific shortfalls in reading, writing, spatial orientation, and finger recognition.9 Distinguishing Gerstmann Syndrome from similar conditions is crucial for accurate diagnosis.

Differential diagnosis from related conditions

In order for an accurate diagnosis, being able to distinguish Gerstmann Syndrome from similar conditions is essential. The unique combination of symptoms, including right-left confusion, finger agnosia, agraphia, and acalculia, sets Gerstmann Syndrome apart from other disorders like dyslexia. Careful consideration of motor and cognitive impairments, along with neuropsychological assessment and brain imaging, ensures accurate diagnosis.6  

Treatment and Management

Rehabilitation strategies

Whilst there is no cure for Gerstmann Syndrome, rehabilitation strategies  focus on  specific motor and cognitive symptoms.  Speech  and occupational therapy  address finger agnosia, acalculia and agraphia, improving reading, writing, spatial awareness, and finger recognition through exercises and activities.10  

These various rehabilitation strategies not only improve functional independence but also enhance the overall quality of life for individuals affected by Gerstmann Syndrome. 

Adaptive techniques for daily activities 

Whilst rehabilitation strategies are an excellent form of long term management, adaptive techniques play a key role in assisting individuals with the challenges posed by their motor and cognitive impairments throughout day-to-day life. These techniques involve various practical strategies to help individuals with their difficulties in spatial orientation, finger recognition, reading and writing. For example, using mnemonic aids and colour-coded cues can help individuals distinguish between right and left. By using various digital tools such as speech-to-text software individuals can navigate around the impact of acalculia and agraphia.6

These adaptive techniques can empower individuals to independently carry out daily activities which would otherwise be very difficult, allowing for a sense of independence and improved functionality despite the challenges posed by the syndrome. 


Gerstmann syndrome is a complex and rare neurological disorder with four main symptoms; right and left confusion, acalculia inability to carry out mathematical calculations), agraphia (difficulty writing) and finger agnosia (inability to distinguish different fingers). These symptoms are the result of disruptions in several different areas of the brain which are responsible for motor control, spatial awareness and language processing. These disruptions can be caused by a range of factors such as strokes, developmental issues and brain injuries. There are various methods of diagnosis for Gerstmann syndrome, most commonly a neuropsychological assessment is conducted in order to distinguish this syndrome from other related conditions. Treatment and management strategies such as adaptive techniques and rehabilitation strategies aim to improve an individual's functional abilities, help to gain independence and improve their overall quality of life.  Whilst Gerstmann syndrome is a very complex disorder, by understanding this syndrome and the complex connections between motor and cognitive functions provides an insight into effective diagnosis and treatment strategies available for those affected with Gerstmann Syndrome.


  1. Kaufman DM, Geyer HL, Milstein MJ, Rosengard JL. 8 - aphasia and anosognosia. In: Kaufman DM, Geyer HL, Milstein MJ, Rosengard JL, editors. Kaufman’s Clinical Neurology for Psychiatrists (Ninth Edition) [Internet]. New Delhi: Elsevier; 2023 [cited 2023 Aug 8]. p.159–83.  Available from: https://www.sciencedirect.com/science/article/pii/B9780323796804000085
  2. Ardila A. A proposed reinterpretation of gerstmann’s syndrome. Archives of Clinical Neuropsychology [Internet]. 2014 Dec 1 [cited 2023 Aug 8];29(8):828–33. Available from: https://academic.oup.com/acn/article-lookup/doi/10.1093/arclin/acu056
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  4. Domboski K, Mittenberg W. Gerstmann syndrome. In: Goldstein S, Naglieri JA, editors. Encyclopedia of Child Behavior and Development [Internet]. Boston, MA: Springer US; 2011 [cited 2023 Aug 8]. p. 697–701. Available from: https://doi.org/10.1007/978-0-387-79061-9_1238
  5. Rusconi E. Chapter 20 - Gerstmann syndrome: historic and current perspectives. In: Vallar G, Coslett HB, editors. Handbook of Clinical Neurology [Internet]. Elsevier; 2018 [cited 2023 Aug 8]. p. 395–411. (The Parietal Lobe; vol. 151). Available from: https://www.sciencedirect.com/science/article/pii/B9780444636225000206
  6. Gerstmann’s Syndrome | National Institute of Neurological Disorders and Stroke [Internet]. [cited 2023 Aug 9]. Gerstmann’s Syndrome. Available from: https://www.ninds.nih.gov/health-information/disorders/gerstmanns-syndrome
  7. Shahab QS, Young IM, Dadario NB, Tanglay O, Nicholas PJ, Lin YH, et al. A connectivity model of the anatomic substrates underlying Gerstmann syndrome. Brain Communications [Internet]. 2022 May 2 [cited 2023 Aug 9];4(3):fcac140. Available from: https://academic.oup.com/braincomms/article/doi/10.1093/braincomms/fcac140/6594104
  8. Rusconi E, Pinel P, Dehaene S, Kleinschmidt A. The enigma of Gerstmann’s syndrome revisited: a telling tale of the vicissitudes of neuropsychology. Brain [Internet]. 2010 Feb 1 [cited 2023 Aug 9];133(2):320–32. Available from: https://academic.oup.com/brain/article-lookup/doi/10.1093/brain/awp281
  9. Altabakhi IW, Liang JW. Gerstmann syndrome. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 [cited 2023 Aug 9]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK519528/
  10. Gerstmann’s Syndrome (Symptoms and management) [Internet]. 2021 [cited 2023 Aug 9]. Available from: https://patient.info/doctor/gerstmanns-syndrome
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

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Vanessa Crowle

Bachelor of Science - BSc Biomedical Science, Anglia Ruskin University, England

Vanessa is currently a masters student, completing her master’s degree in medical microbiology, alongside working as an experienced medical writer intern.

Vanessa’s master’s course focused on key areas of microbiology, with a central focus on patient diagnosis. Her research specialises in breast cancer treatment and antibiotic resistance and she looks forward to writing more about life and health sciences to help deliver knowledge to the general public.

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