Information on the following diseases can be found in the Related Disorders section of this report:

• None

Gerstmann syndrome is a rare disorder characterized by the loss of four specific neurological functions: Inability to write (dysgraphia or agraphia), the loss of the ability to do mathematics (acalculia), the inability to identify one's own or another's fingers (finger agnosia), and inability to make the distinction between the right and left side of the body. It is very rare for a person with learning disabilities to have all four of these neurologic dysfunctions. Only when all four symptoms appear together without mental retardation is the classic syndrome present.

When affected individuals have all four of the characteristic symptoms of Gerstmann syndrome without other cognitive defects, the condition may be referred to as "pure" Gerstmann syndrome. However affected individuals usually have other defects in addition to the classic four findings of Gerstmann syndrome. In addition, many individuals have only two or three of the four key findings in combination with other types of cognitive defects.

In such cases in addition to the four classical symptoms, affected individuals may also have difficulty expressing themselves through speech, and/or difficulty understanding another person's speech (aphasia). They may experience difficulty in reading and spelling as well.

A few cases have been reported in children and called developmental Gerstmann syndrome. These cases usually become apparent when children begin school. Affected children may demonstrate poor handwriting, spelling and math skills (e.g., difficulty adding, subtracting, dividing and multiplying). Some children have difficulty reading or understanding written words (alexia) and difficulty copying or tracing simple objects (constructional apraxia).

Some researchers suggest that developmental Gerstmann syndrome is not a true, unique syndrome, but rather a group of symptoms caused by another, underlying disorder.

IIn adults, the syndrome can arise in adults as a result of impaired blood flow to the brain (cerebrovascular disease) such as a stroke or other damage to the brain. The parietal lobes (upper side lobes) of the brain are affected in Gerstmann syndrome. The parietal lobes are involved with sensation and perception as well as understanding sensory input.

In rare cases, traumatic brain injury or a brain tumor in the same region of the brain can cause the various symptoms associated with Gerstmann syndrome.

The cause of Gerstmann syndrome in children is often unknown. Although in some cases it may be linked to brain damage, children without brain damage can also be affected.

Gerstmann syndrome affects males and females in equal numbers. The incidence of Gerstmann syndrome in the general population is unknown. The disorder was first described by Dr. Josef Gerstmann, a Viennese neurologist, in 1924.

Symptoms of the following disorders can be similar to those of Gerstmann syndrome. Comparisons may be useful for a differential diagnosis:

Alzheimer disease is a progressive condition of the brain that affects memory, thought, and language. The degenerative changes of Alzheimer disease lead to patches or plaques in the brain and the entanglement of nerve fibers (neurofibrillary tangles). Memory loss and behavioral changes occur as a result of these changes in brain tissue. The characteristic findings associated with Gerstmann syndrome can occur due to Alzheimer disease. (For more information on this disorder, choose "Alzheimer's" as your search term in the Rare Disease Database).

Additional disorders may cause brain dysfunction and could potentially cause the four characteristic findings associated with Gerstmann syndrome. These characteristic findings have also been seen in alcoholics, lupus, carbon monoxide poisoning, and lead poisoning.

Diagnosis
The presence in the adult of all four neurological symptoms suggests a diagnosis of Gerstmann syndrome, especially when other causes of these symptoms are ruled out. Among children, most cases are recognized at school age when the affected person has difficulty in math and writing. Affected children may also have problems in spelling, performing the basic four mathematical calculations, and distinguishing left from right. Also, they generally fail the finger identification test. Many, but not all such children will find it difficult to copy simple drawings (constructional apraxia).

Treatment
Treatment of Gerstmann syndrome in developmental cases will involve special education and related rehabilitation and counseling services. Neurological examination is necessary to tell the difference between the two causes of the condition. In adults, treatment of the underlying neurological condition is necessary. When brain injury or tumor is involved, surgery may be used to alleviate the condition. In some cases, the symptoms affecting adults with Gerstmann syndrome diminish over time.

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government web site.

For information about clinical trials being conducted at the NIH Clinical Center in Bethesda, MD, contact the NIH Patient Recruitment Office:

Toll free: (800) 411-1222
TTY: (866) 411-1010
Email: prpl@cc.nih.gov

For information about clinical trials sponsored by private sources, contact:
www.centerwatch.com

TEXTBOOKS
Anderson SW, Benton A. Gerstmann Syndrome. In: NORD Guide to Rare Disorders. Lippincott Williams & Wilkins. Philadelphia, PA. 2003:534-535.

Adams RD, Victor M, Ropper AA. Eds. Principles of Neurology. 6th ed. McGraw-Hill Companies. New York, NY; 1997:457-59.

Fauci AS, Braunwald E, Isselbacher KJ, et al. Eds. Harrison's Principles of Internal Medicine. 14th ed.McGraw-Hill Companies. New York, NY; 1998:138.

JOURNAL ARTICLES
Vallar G, Spatial neglect, Balint-Homes' and Gerstmann's syndrome, and other spatial disorders. CNS Spectr. 2007 Jul;12(7):527-36

Noël MP. Finger gnosia: a predictor of numerical abilities in children? Child Neuropsychol. 2005 Oct;11 (5):413-30

Miller CJ. Whatever happened to development Gerstmann's syndrome? Links to other pediatric, genetic, and neurodevelopmental syndromes. J Child Neurol. 2004;19:282-89.

Wingard EM, Barrett AM, Crucian CP, et al. The Gerstmann syndrome in Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2002;72:403-05.

von Aster M. Developmental cognitive neuropsychology of number processing and calculation: varieties of developmental dyscalculia. Eur Child Adolesc Psychiatry. 2000;9:II41-57.

Suresh PA, Sebastian S. Developmental Gerstmann's syndrome: a distinct clinical entity of learning disabilities. Pediatr Neurol. 2000;22:267-78.

Mayer E, Martory MD, Pegna AJ, et al. A pure case of Gerstmann syndrome with a subangular lesion. Brain. 1999:12:697-701.

Sukumar S, Ferguson GC. Gerstmann's syndrome. Postgrad Med J. 1996;72:314.

Benton AL. Gerstmann's syndrome. Arch Neurol. 1992;49:445-47.

PeBenito R, Fisch CB, Fisch ML. Developmental Gerstmann's syndrome. Arch Neurol. 1988;45:977-82.

FROM THE INTERNET
National Institute of Neurological Disorders and Stoke. Gerstmann's Syndrome Information Page. February 13, 2007. Available at: www.ninds.nih.gov/health_and_medical/disorders/gerstmanns.htm Accessed on: March 27, 2008.