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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
The third symptom is called finger agnosia. Here's how Gerstmann described this symptom: “it manifests itself as an isolated disturbance in the recognition, naming, choosing, and differential exhibition of the various fingers of both hands—one's own fingers as well as those of another person” (Gerstmann, 1930, translated by Wilkins & Brody, 1971, p. 476). What Gerstmann missed back then is that the symptom would be better called digit agnosia because the toes can also be involved (Tucha et al., 1997). Specifically, a person with digit agnosia has trouble pointing to and naming individual fingers or toes when they are touched or pointed at, especially the middle three fingers (Pyrtek et al., 2020). For example, the doctor may point to the person's middle finger and ask them to bend it, but they may move their ring finger instead. Or, the doctor may point to their middle finger and ask them which finger is being pointed at, but the person might incorrectly say, “that's my pointer finger.” Digit agnosia should be specifically tested for in cases of brain damage due to how easy it is to overlook in some cases, because it doesn't cause many problems in day-to-day life (Della Sala & Spinnler, 1994).
ENTRIES A–Z
Published in Philip Winn, Dictionary of Biological Psychology, 2003
The failure to localize and/or identify fingers occurs with approximately equal frequency in patients with RIGHT HEMISPHERE and LEFT HEMISPHERE brain damage and may be associated with many types of damage including diffuse lesions in the posterior PARIETAL LOBE, FRONTAL LOBE and TEMPORAL LOBE. Finger agnosia is not simply attributable to a failure to point to PROXIMAL body parts and patients may fail even on pointing to different fingers on a drawing of a hand. This deficit was originally described as part of the GERSTMANN SYNDROME which includes a combination of finger agnosia, LEFT-RIGHT CONFUSION, ACALCULIA and AGRAPHIA although it may occur in isolation as well.
Posterior cortical atrophy: clinical, neuroimaging, and neuropathological features
Published in Expert Review of Neurotherapeutics, 2023
John Best, Marianne Chapleau, Gil D. Rabinovici
Following Benson’s initial report, additional case series were published highlighting the clinical and radiographic features of PCA. Presenting symptoms classically include a variety of deficits in higher-order visual processing but can also include a number of nonvisual deficits which localize toposterior parietal regions. The most frequent visual symptoms are spatial perception deficits (i.e. where objects are in space) as well as object perception deficits (i.e. visual agnosia). Patients develop features of Gerstmann Syndrome, including agraphia (inability to write), acalculia (impaired mental calculations), finger agnosia (loss of ability to name and distinguish fingers), and right-left dissociation. Features of Balint syndrome, including oculomotor apraxia (impaired voluntary and purposeful eye movements), optic ataxia (inability to accurately reach toward an object under visual guidance), and simultanagnosia (the inability to simultaneously process and integrate multiple visual inputs), are also commonly present. Visual field defects are often detected, especially when formally assessed with perimetry. Function in other cognitive domains is generally preserved until more advanced stages of the disease, although visual memory can be impacted early in the disease course [2]. The syndrome’s name is derived from the profound atrophy, hypometabolism and hypoperfusion of parieto-occipital and parieto-temporal visual association cortices noted on structural and functional brain imaging [1,3]. Neuropathologic series of patients diagnosed with PCA during life and followed to autopsy have found that the PCA clinical syndrome is most frequently associated with Alzheimer’s disease (AD) neuropathologic changes and is therefore sometimes referred to as the ‘visual variant of AD’ The most common alternative pathologies are Lewy Body Disease and corticobasal degeneration [4,5]. Prion disease has been described with an initial PCA presentation but is exceedingly rare [4].