A-181: When Left Isn’t Right: Neuropsychological Case Presentation Findings in an Adult With Gerstmann Syndrome

Abstract

Objective: Gerstmann Syndrome (GS) is a rare neurological disorder characterized by a tetrad of symptoms following dominant-hemisphere parietal lobe lesion or injury. Primary symptoms include acalculia, agraphia, left-right disorientation, and finger agnosia that aligns with angular and supramarginal gyri involvement (Ardila, 2020). Current literature suggests clinical presentation of all four components is rare. There are limited case studies examining neuropsychological outcomes, particularly in younger and middle-aged adults. Method/Data Selection: This study highlights a unique case of a 52-year-old, right-handed, White female who presented for an outpatient neuropsychological evaluation one year following left intraparenchymal and subdural hemorrhage s/p left parietal craniotomy. Hospitalization notes documented agraphia, alexia, left-right confusion, and finger agnosia following injury. Most recent brain MRI revealed encephalomalacia and gliosis of the left parietal lobe. Results/Data Synthesis: Difficulties with non-verbal learning/memory, math computation, processing speed, fine motor, and executive functioning were noted. Visuospatial abilities were variable, notably impacted by visual deficits. Left-right confusion and acalculia were demonstrated, though finger agnosia, alexia, and agraphia improved from inpatient assessment. Attention and verbal learning/memory were cognitive strengths. Some word-finding difficulty in conversation was observed; however, expressive language abilities are intact. Her presentation was consistent with Major Neurocognitive Disorder due to brain injury, given ongoing challenges with instrumental activities. Additional recommendations to maximize quality of life were shared with the patient. Conclusions: This complex case depicts a rare clinical occurrence of tetrad of GS symptoms post-injury. Cognitive testing depicts significant gains/strengths as well as challenges in GS that warrant important consideration in treatment recommendations and adjustment to injury in adults.