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п»ї<title>Gerstmann syndrome, the inability to recognize the fingers</title>
Gerstmann syndrome is a rare neurological disease. It is known for its most prominent feature: the patient's inability to recognize his or her own fingers. However, beyond this symptom, it is a much more complex and acquired disease -the set of symptoms appear after some injury-.
Its name comes from Josef Gerstmann, a young assistant at the Department of Neurology of the University of Vienna, Austria. This student described a set of symptoms in a woman who had suffered a stroke. From then on, the disease composed of agraphia, digital agnosia and acalculia, would bear his name.
The causes of Gerstmann's syndromeFirst of all, it should be noted that most reported cases arise from a vascular problem. This seems to be the main cause of a syndrome characterized by the dissolution of the morphological knowledge of the hands and the inability to operate with them. The symptomatology can then be summarized as:
Digital agnosia. Inability to recognize the fingers of the hands. The patient acts as if he does not count with his fingers, as if he did not have them.
Agraphia. In conjunction with the previous symptom, these people lose the ability to express themselves through writing.
Acalculia. Subjects with Gerstmann syndrome also lose the ability to perform simple arithmetic operations.
Disorientation. Inability to orient themselves correctly in space, confusing or not recognizing the distinction between left and right.
Acquired damageIn 1930, Gerstmann completed the description of the syndrome by studying the lesions of his patients. It was found that most had damage to the dominant parietal lobe, more specifically the angular gyrus.
In the parietal lobe lies Penfield's homunculus, a somatosensory mapping of the body. Within the parietal lobe there is a specific area focused on the fingers.
This area is much larger in proportion to the rest of the body, due to the importance and number of nerve terminals our hands have.
The angular gyrusThis area especially damaged in Gerstmann syndrome occupies a posterior portion of the parietal lobe. It is related to the interpretation of language, the assignment of a common code for visual and auditory information.
Patients with this syndrome usually present with a vascular accident in the left middle cerebral artery, which supplies the angular gyrus.
Clinical featuresIt should be clarified that Gerstmann's syndrome usually presents incompletely. This means that the three main symptoms do not have to be necessarily expressed in order to make a diagnosis.
In many cases, agraphia is not present and instead semantic aphasia, a defect in the comprehension of logical-grammatical structures, is very common.
Gerstmann syndrome todaySince the syndrome was described a long time ago, the advance of science has meant that many of its components are under debate. The organic basis of the syndrome is currently debated, with other areas of the parietal lobe being proposed in the etiology of the syndrome.
Most patients present lesions in the left parietal lobe, the dominant hemisphere in the majority of the right-handed population. The abnormalities occur at the cortical level, thus in areas of complex processing.
DiagnosisThe main disciplines involved in the diagnosis of this syndrome are neurology and neuropsychology. Suspicions usually become evident when tasks involving finger recognition are proposed.
From neurology, the diagnosis begins with exploratory tests and is confirmed by CT or MRI scans that allow the damaged tissue to be seen. Likewise, neuropsychology is responsible for evaluating and assessing impaired cognitive abilities through clinical observation.
TreatmentTreatments are also divided and differentiated according to the specialist. In summary, a combined approach from neurology and psychology is always necessary.
Neurological treatment. The approach is based on the attention of the organic damage through standardized procedures. Then the treatment will depend on whether the cause was vascular or due to a brain tumor.
Neuropsychological treatment. This approach is based on working on the cognitive functions affected by the lesion. In addition, given the variability of symptoms, treatment should be individualized and multidisciplinary.
Psychoeducation. Information and awareness about the syndrome are very important to work on the underlying emotional aspects.
Finally, both treatments should be focused on the functional recovery of the patient. With goals that seek optimal functioning and discourage isolation.
In principle, although Gerstmann's syndrome is rare among the general population, it has attracted the attention of researchers and specialists because of its characteristics.
The interest lies in the fact that the correct functioning of the brain also depends on the correct vascular functioning. Therefore, all activities that constitute a risk factor for the circulatory system are also a danger for the nervous system.
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