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Gerstmann Syndrome (Dysgraphia, Dyscalculia, Finger Agnosia, and Left-Right Disorientation)
Published in Alexander R. Toftness, Incredible Consequences of Brain Injury, 2023
Many people spend a great deal of time during their childhood training their brains to trace loops and arrange shapes into legible letters that face in the correct directions. That practice helps to make writing an almost automatic process once you are an adult. But, behind the scenes, the brain is constantly following electrochemical recipes to produce those detailed strings of symbols. Agraphia may result from damage to these recipes or, more specifically, damage to the processes in the brain that contribute to selecting words, arranging letters, spelling, and a number of other complex calculations that the brain usually performs relatively effortlessly (Anderson et al., 2009).
Assessment of the stroke patient
Published in Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees, Stroke in Practice, 2017
Christos Tziotzios, Jesse Dawson, Matthew Walters, Kennedy R Lees
Agraphia should raise suspicion for exotic entities that could impress your consultant if diagnosed, and you should ask the patient to name individual fingers and test the ability to perform basic calculations. Finger agnosia is the inability to carry out this task and is part of Gerstman’s syndrome (acalculia, agraphia, left-right confusion, and finger agnosia), which results from lesions of the angular gyrus of the dominant parietal lobe.
Optic radiations
Published in Fiona Rowe, Visual Fields via the Visual Pathway, 2016
Temporal and parietal lobe lesions can cause higher cortical deficits including complex partial seizures, auditory or complex visual hallucinations, memory problems or a Wernicke’s aphasia (Penfield 1954). Other features of temporal and parietal lobe disease include paroxysmal olfactory or gustatory hallucinations, agraphia, acalculia, graphesthesia and sensory aphasia (Rowe et al. 2009). Aphasia is a loss of ability to produce correct speech which may be receptive, expressive or global. Agraphia is impaired writing ability. Acalculia is a form of aphasia characterized by the inability to perform simple mathematical problems. Graphesthesia is a tactual inability to recognize writing.
Dysfunction of the left angular gyrus may be associated with writing errors in ALS
Published in Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, 2021
Toru Sakurai, Shigeki Hirano, Midori Abe, Yuriko Uji, Keisuke Shimizu, Masahide Suzuki, Yoshikazu Nakano, Ai Ishikawa, Kazuho Kojima, Kazumoto Shibuya, Atsushi Murata, Satoshi Kuwabara
Lower perfusion in the left frontal lobe and bilateral parietal lobe, was demonstrated in the ALS with writing errors group compared with the ALS without writing errors group. The posterior middle frontal gyrus of the dominant side (i.e. Exner’s area) is classically considered as the writing center as demonstrated by stroke studies and direct cortical stimulation (43,44). A single ALS autopsy case showed that bilateral frontal lobe damage—most prominent in the left middle frontal gyrus—was associated with isolated agraphia (45). Some perfusion-SPECT-based studies of ALS have speculated that the cause of agraphia may be hypo-perfusion in the frontal lobe; however, the number of patients included in those studies was small and the results were obtained from a single-case observation compared with a normal database. Therefore, these studies lack direct evidence with functional severity and are insufficient to draw conclusions (16,17).
Maximising recovery from aphasia with central and peripheral agraphia: The benefit of sequential treatments
Published in Neuropsychological Rehabilitation, 2019
Pélagie M. Beeson, Chelsea Bayley, Christine Shultz, Kindle Rising
In summary, as BB approached one year post stroke she exhibited anomic aphasia with marked phonological impairment that was evident on phonological manipulation tasks, as well as those that required phonology–orthography transcoding. Along with the word retrieval impairment, the most significant problem for BB was her inability to communicate in writing. Although she retained spelling knowledge for many words, she could not write well-formed, grammatically correct sentences. This phonological text agraphia profile was accompanied by degraded memory for letter shapes (allographic impairment), making written communication even more challenging. Additional complicating factors included some disturbance of visuospatial processing and visual problem-solving, and mild semantic impairment.
White matter—Maximien Parchappe and the integration of articulate language
Published in Journal of the History of the Neurosciences, 2020
Two of the patients Wernicke reported suffered from agraphia (Patient 1), and alexia (Patient 3). Wernicke thought these deficits arose from damage to the visual cortex. Jules Dejerine (1849–1917), however, localized alexia and agraphia to the angular gyrus and linked it to Wernicke’s area through a branch of the arcuate fasciculus (Dejerine 1891). The following year, Dejerine described pure alexia, and linked the angular gyrus to the ipsilateral calcarine cortex and to the calcarine cortex of the opposite hemisphere, through the inferior longitudinal fasciculus and fibers of the splenium of the corpus callosum (Dejerine 1891, 1892; see Figure 3). Like Meynert and Wernicke, Dejerine did not cite Parchappe, who fared no better with Henry Charlton Bastian (1837–1915). Bastian restated Parchappe’s theory almost textually, without attribution, in, “A Treatise on Aphasia and Other Speech Defects”: The cerebral cortex is in my view, to be regarded as a continuous aggregation of interlaced “centers” and associated fibers, towards which ingoing impressions of all kinds converge from all parts of the body; and also of other related regions in which higher, or derivative, mental processes are in part carried on. … From these terminals and complexly related “end-stations” … out going currents issue which rouse in definite ways the activity of the motor centers in the bulb and in the cord, so as to give rise to any movement that may be “desired,” or which are accustomed to appear in response to particular ideas or sensations. (Bastian 1898, 17–18)