Right-Left Confusion in Gerstmann' S Syndrome: A Model of Body Centered Spatial Orientation

Gerstmann's syndrome encompasses the tetrad of finger agnosia, agraphia, acalculia and right-left confusion and is associated with lesions of the dominant angular gyrus. The localizing value of this syndrome has been questioned because multiple mechanisms can account for each of the components of the syndrome. We present the case of a man who developed Gerstmann's syndrome following a focal infarct of the left angular gyrus. The patient's right-left confusion could not be accounted for by either an aphasia or a degraded body schema. A series of experiments that investigated the patient's spatial mapping system by progressively restricting the degrees of freedom for spatial rotation revealed an isolated defect in deriving the relative position of an object along the horizontal axis. Defective horizontal mapping can account for the other components of Gerstmann's syndrome because they all share a common dependency on relative horizontal positioning.

[1]  R. Shepard,et al.  Mental Rotation of Three-Dimensional Objects , 1971, Science.

[2]  L. Weiskrantz,et al.  Impairments of visual object transforms in monkeys. , 1984, Brain : a journal of neurology.

[3]  Domenico Passafiume,et al.  Calculation Disturbances in Adults with Focal Hemispheric Damage , 1982, Cortex.

[4]  E. A. Berg,et al.  A simple objective technique for measuring flexibility in thinking. , 1948, The Journal of general psychology.

[5]  A. Benton Reflections on the Gerstmann syndrome , 1977, Brain and Language.

[6]  F. Plum,et al.  Hyperphagia, rage, and dementia accompanying a ventromedial hypothalamic neoplasm. , 1969, Archives of neurology.

[7]  K M Heilman,et al.  A comparison of the influences of body and environment centred reference frames on neglect. , 1994, Brain : a journal of neurology.

[8]  P. Fischer,et al.  Right‐1eft disorientation in dementia of the Alzheimer type , 1990, Neurology.

[9]  A. Benton THE FICTION OF THE “GERSTMANN SYNDROME” , 1961, Journal of neurology, neurosurgery, and psychiatry.

[10]  Elizabeth K. Warrington,et al.  Visual Apperceptive Agnosia: A Clinico-Anatomical Study of Three Cases , 1988, Cortex.

[11]  A. Taylor,et al.  The contribution of the right parietal lobe to object recognition. , 1973, Cortex; a journal devoted to the study of the nervous system and behavior.

[12]  H. Klonoff,et al.  Right and left orientation in children aged 5 to 13 years. , 1990, Journal of clinical and experimental neuropsychology.

[13]  R. Reitan,et al.  Implications of Gerstmann's syndrome , 1964, Journal of neurology, neurosurgery, and psychiatry.

[14]  E. Stengel Loss of Spatial Orientation, Constructional Apraxia and Gerstmann's Syndrome , 1944 .

[15]  D. Bub,et al.  Semantic memory loss in dementia of Alzheimer's type. What do various measures measure? , 1990, Brain : a journal of neurology.

[16]  B. Poucet Spatial cognitive maps in animals: new hypotheses on their structure and neural mechanisms. , 1993, Psychological review.

[17]  D. Benson,et al.  Angular gyrus syndrome simulating Alzheimer's disease. , 1982, Archives of neurology.

[18]  M. Critchley The enigma of Gerstmann's syndrome. , 1966, Brain : a journal of neurology.

[19]  E. Warrington,et al.  A study of finger agnosia. , 1962, Brain : a journal of neurology.