Gerstmann’s syndrome in a patient with left thalamic hemorrhage

A 78-year-old right-handed man presented with mild right hemiplegia and impaired deep sensation on his right side. He had no aphasia, but showed Gerstmann’s syndrome which is characterized by four primary symptoms: fi nger agnosia, right-left disorientation, agraphia, and acalculia. A cranial CT revealed hemorrhagic lesions in the left thalamus, and single photon emission CT showed decreased regional cerebral blood fl ow in the superior portion of the left temporoparietal lobe, especially angular gyrus area. It is infered that in this case, corticofugal fi bers from the thalamus to the parietal lobe had been damaged by hemorrhage, secondarily causing decreased function of the cerebral cortex. Neurology Asia 2009; 14(2) : 161 – 164 Address correspondence to: Dr. Aiko Osawa, Department of Rehabilitation Medicine, Saitama Medical University International Medical Center, 1397-1 Hidaka, Saitama 350-1298, Japan. Tel: +81 42 984 4548, Fax: +81 42 984 4741, e-mail: [email protected] INTRODUCTION Gerstmann’s syndrome is characterized by four symptoms agraphia, acalculia, fi nger agnosia, and right-left disorientation. This syndrome has been well known as a focal symptom of the angular gyrus region in the dominant hemisphere. It is reported that lesions in the thalamus also cause cerebral cortical symptoms, but most of them are unilateral spatial neglect or aphasia. We present a case of Gerstmann’s syndrome caused by hemorrhage in the left thalamus.