A Tetrad Cognitive Presentation of Gerstmann Syndrome: A Rare Manifestation of Stroke

Gerstmann Syndrome is a rare neurological presentation due to lesion in the left dominant parietal lobe, manifesting as tetrad of agraphia, acalculia, finger agnosia and right-left disorientation. We present case 52-year-old man, right hand dominant, who presented Emergency Department with acute confusion for one day. He was disorientated time, place person. Focused examination revealed atypical signs stroke, comprising Stroke protocol activated he underwent computed tomography brain perfusion, which confirmed large penumbra area at middle cerebral artery territory. Computed angiogram carotid arteries showed long segment thrombosis internal artery. thrombectomy abandoned impenetrable hard thrombus. treated dual antiplatelet therapy discharged after three days partial improvement terms following commands, simple calculations reduced agnosia. scheduled outpatient follow up. This highlights syndrome an manifestation stroke.