Gerstmann’s Syndrome: When You Do Not Recognize Your Fingers

Gerstmann’s syndrome is a rare neurological disease. It is best known for its most prominent characteristics: the patient’s inability to recognize his own fingers.

In addition to this symptom, however, it is a much more complex and acquired disease. This means that the symptoms occur after incurring some form of injury or illness.

This disorder is named after Josef Gerstmann,  a young assistant in the Department of Neurology at the University of Vienna in Austria. This student described a range of symptoms in a woman suffering from a stroke. From that moment, the disorder, consisting of agrafia, digital anoxia and acalculia, got its name.

The causes of Gerstmann’s syndrome

First of all, we should note that most reported cases occur due to a vascular problem. It seems to be the primary cause of this syndrome, which is characterized by an inability to use or recognize the fingers. Here are the most common symptoms of this disorder:

• First of all, digital agnosia. The inability to recognize the fingers. The patient acts as if he or she had no fingers.
• Graphics. In conjunction with the above symptom, these patients lose the ability to express themselves through writing.
• Akalkuli. Patients with Gerstmann’s syndrome also lose the ability to perform simple arithmetic.
• Finally, disorientation. The inability to orient oneself properly on a spatial level as well as confusion, not just recognition, according to the distinction between left and right.

Acquired injury in Gerstmann’s syndrome

In 1930, Gerstmann finally decided to describe the syndrome, after studying his patients’ injuries. He found that most had an injury in the dominant ice sheet, more specifically in the angular gyrus.

The Penfield homunculus, a somatosensory map of the body, is located in the ice sheet. In the ice patch, there is a specific area that focuses on the fingers. This area is much larger in forehold to the rest of the body,  due to the importance and amount of nerve endings our hands have.

Angular rotation

This area, which is specifically affected in Gertmann’s syndrome, occupies the lower part of the ice sheet. It is related to the interpretation of language, which is the task of a common code of visual and auditory information.

As a rule, patients with this syndrome have vascular damage in the left, middle cerebral artery, which irrigates the angular gyrus. 

Clinical characteristics

Therefore, we must state that Gertmann’s syndrome often occurs in an incomplete way. This means that the three primary symptoms do not have to be present to make a diagnosis. 

In many cases, there is no sign of agraphy. Instead, semantic aphasia is very common. It is a defect in the understanding of logical-grammatical structures.

Gerstmann’s syndrome today

When the syndrome was described many years ago, scientific advances have debated many of its components. Scientists are discussing, at present, the organic basis of the disease. They suggest other areas of the ice sheet when it comes to the etiology behind this syndrome. 

Most patients have lesions in the western part of the islet lobe, which is the dominant hemisphere in most of the right-handed population. Therefore, abnormalities occur at a cortical level in areas of complex processing.

Diagnosis

The primary disciplines working with the diagnosis of this syndrome are neurology and neuropsychology. The suspicion of this syndrome often becomes apparent when the affected patient has to perform tasks involving finger recognition.

From a neurological point of view, the diagnosis begins with various tests. Next, a doctor will confirm it using tomography or MRI scan that allows him or her to see any damaged tissue. Likewise, neuropsychology is responsible for evaluating and, secondly, assessing impaired cognitive abilities through clinical observation.

Treatment

There are different treatments, according to each individual specialist. In short, a combined neurological and psychological approach is always necessary. 

• Neurological treatment. This approach focuses on organic damage through standardized procedures. The treatment will, next, depend on whether the cause was vascular or due to a brain tumor.
• Neuropsychological treatment. This approach affects the cognitive functions affected by the injury. In addition to this, due to the variation in symptoms, treatment must be individualized and multidisciplinary.
• Psychological education. Information and awareness of the syndrome is very important in order to work on the underlying, emotional aspects.

In conclusion, both physicians and experts should focus on the treatment of patients’ functional healing. Therefore, their goals must seek optimal function and counteract isolation.

In principle, although Gerstmann’s syndrome is rare among the general population, it has caught the attention of researchers and specialists because of its characteristics. 

The interest lies in the fact that the proper functioning of the brain also depends on the proper functioning of the circulation. Therefore, all the activities that involve a risk factor for the circulation will also be a danger to the nervous system.