Q; What is Gerstmann syndrome? 


Answer: Gerstmann syndrome is a combination of patient's symptoms of acalculia, agraphia, finger agnosia, and right-left disorientation. This is due to infarcts involving Left posterior cerebral artery (PCA) territory.

In contrast, infarcts involving right PCA territory presents as difficulty in recognizing familiar faces, spatial disorientation, and visual neglect.

Clinical pearl to remember in either right or left posterior cerebral artery (PCA) territory infarcts is that they are due to embolism from the heart, aorta, or vertebral arteries. Dissection of the PCAs is very uncommon. The most frequent finding in patients with PCA territory infarction is a hemianopia. All of the above findings described are in addition and to differentiate between right and left PCA.


References:

1.  Caplan L. Posterior circulation ischemia: then, now, and tomorrow. The Thomas Willis Lecture-2000. Stroke 2000; 31:2011.
2. Yamamoto Y, Georgiadis AL, Chang HM, Caplan LR. Posterior cerebral artery territory infarcts in the New England Medical Center Posterior Circulation Registry. Arch Neurol 1999; 56:824. 
3. Benson DF, Marsden CD, Meadows JC. The amnesic syndrome of posterior cerebral artery occlusion. Acta Neurol Scand 1974; 50:133.