Gerstmann syndrome

Clinical History

A 55-year-old man presented with a 2-month history of difficulty picking things up with his right hand and increasing problems with reading and writing. On examination he had sensory ataxia and finger agnosia.

Imaging Findings

Computed tomography (CT) and Magnetic Resonance Imaging (MRI) were performed and showed an irregular and centrally necrotic mass in the left parietal lobe at the angular gyrus, with surrounding vasogenic oedema. (Figure 1 and Figure 2) in keeping with a high-grade glioma.

Discussion

A. Background: Gerstmann's Syndrome (GS) is a neuropsychological disorder characterised by finger agnosia, agraphia, acalculia and left-right disorientation secondary to a lesion in the dominant (usually left) hemisphere in the region of the angular gyrus and supramarginal gyrus [1, 2].
Differential diagnoses for GS include infarction, haemorrhage and extra-axial collections.
GS may be due to intraparietal disconnection after damage to a focal region of subcortical white matter [1].
B. Outcome: The tumour was resected with the patient awake and he received neuro-rehabilitation afterwards. Subsequent histopathology confirmed a diagnosis of glioblastoma multiforme (GBM) (Fig. 3).
C. Take Home Message and Teaching Point: Detailed neuro-examination is still vital for localisation of any nervous system pathology even in the presence of advanced imaging.

Differential Diagnosis List

Final Diagnosis

Glioblastoma multiforme causing Gerstmann's Syndrome

URL:	https://www.eurorad.org/case/14092
DOI:	10.1594/EURORAD/CASE.14092
ISSN:	1563-4086