Some Notes on the Gerstmann Syndrome

IN SPITE OF an extensive bibliography on the syndrome of finger agnosia, disorientation for right and left, agraphia, and acalculia, and of the virtually universal recognition of it as a well-defined neurologic symptom-complex resulting from localized involvement of the parieto-occipital region of the dominant hemisphere, there are still misconceptions about the syndrome, as evidenced by an article recently published in this journal.’ Consequently, I would like to present once more the clinicalphenomenologic definition of the syndrome and its associated features and to review the subject briefly in the light of present day experience. In a series of papers? and lectures during the course of many years, I have stated that finger agnosia, first described and so designated by me in 1924,z is a disorder of the body image proper. It consists in a primary disturbance or loss of ability to recognize, identify, differentiate, name, select, indicate, and orient as to the individual fingers of either hand, the patient’s own, as well as those of other persons. Subsequent to this gnostic disorientation with respect to the fingers, restriction in their separate kinetic realization occurs not infrequently. It is characteristically associated with lack of recognition and orientation for the right and left sides in respect to the patient’s own body, as well as that of other persons, often with special reference to the hands and fingers. These disorders are commonly combined with an isolated disability for writing-dysor agraphiaand an isolated disability for calculation -dysor acalculia-of differing severity and definite character, both types of disorder varying in significant respects from the aphasic, apraxic, and spatial-agnostic types. The disturbances tend to aDpear in varying degrees of development. All these symptoms group themselves phenomenologically and psychologically into a well circumscribed syndrome. Investigations in a large number of cases of this type have so far failed to reveal any evidence of psychic or intellectual disorder, aphasia, apraxia, or other manifestations of agnosis (particularly with regard to outer space and objects therein) or of motor or sensow changes to which the symptom-complex of finger agnosia and its accompanying individual features