title: Dyscalculia, dysgraphia, and left-right confusion from a left posterior peri-insular infarct.
abstract: The Gerstmann syndrome of dyscalculia, dysgraphia, left-right confusion, and finger agnosia is generally attributed to lesions near the angular gyrus of the dominant hemisphere. A 68-year-old right-handed woman presented with sudden difficulty completing a Sudoku grid and was found to have dyscalculia, dysgraphia, and left-right confusion. Magnetic resonance imaging (MRI) showed a focus of abnormal reduced diffusivity in the left posterior insula and temporoparietal operculum consistent with acute infarct. Gerstmann syndrome from an insular or peri-insular lesion has not been described in the literature previously. Pathological and functional imaging studies show connections between left posterior insular region and inferior parietal lobe. We postulate that the insula and operculum lesion disrupted key functional networks resulting in a pseudoparietal presentation.
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115, USA ; Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA ; Harvard Medical School, Boston, MA 02115, USA.
authors.forename: S
authors.initials: S
authors.lastname: Bhattacharyya
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115, USA ; Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA ; Harvard Medical School, Boston, MA 02115, USA.
authors.forename: X
authors.initials: X
authors.lastname: Cai
authors.affiliation: Department of Neurology, Brigham and Women's Hospital, 45 Francis Street, Boston, MA 02115, USA ; Harvard Medical School, Boston, MA 02115, USA ; Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Klein
mesh_terms: D000368:Aged; D000381:Agraphia / Q000209:etiology* / Q000473:pathology / Q000523:psychology; D020520:Brain Infarction / Q000150:complications* / Q000473:pathology / Q000523:psychology; D060705:Dyscalculia / Q000209:etiology* / Q000473:pathology / Q000523:psychology; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D008279:Magnetic Resonance Imaging; D010296:Parietal Lobe / Q000473:pathology*; D010468:Perceptual Disorders / Q000209:etiology* / Q000473:pathology / Q000523:psychology; D013028:Space Perception / Q000502:physiology; D013702:Temporal Lobe / Q000473:pathology*