Right-left Disorientation Research Articles

Arithmetic Facts without Meaning

The paper presents a single-case study of patient J.G. showing severe calculation problems (and also agraphia, finger agnosia, right-left disorientation and apraxia) after the surgery of a left parietal tumor. Although the patient completely lost conceptual knowledge of arithmetic, she preserved part of memorised fact knowledge (multiplications and some additions and subtractions). The study indicates that arithmetic facts can be represented at a superficial level without understanding of the operation performed. The study completes a valid double dissociation between two types of knowledge involved in calculation (memorised facts and conceptual knowledge).

Finger Agnosia: Fiction or Reality?

Finger agnosia (FA) may be broadly defined as a finger recognition deficit.^1,2Bilateral FA has been described in association with right-left disorientation, dysgraphia, and dyscalculia as the core of Gerstmann's syndrome.³Although considerable skepticism has been expressed with regard to this association,^4,5it has recently received renewed attention in modern neurology textbooks⁶as well as in the literature.⁷ The existence of FA as an isolated phenomenon, not depending on other disorders such as sensory defects,⁸autotopagnosia,⁹aphasia,¹⁰general mental impairment,¹¹or spatial disorientation,¹²is worth reporting since the debate as to whether FA canbe a "primary" deficit^2,13,14is still open.¹⁵ The issue has been recently reappraised⁷following the demonstration that stimulation of specific cortical areas can elicit FA, unaccompanied by other defects.¹⁶ A 52-year-old right-handed housewife with 5 years of education suffered a sudden, isolated, complete

Dyscalculia in Alzheimer's disease compared to multhnfarct dementia: A. Travniczek-Marterer 1,2, P. Fischer 1,3, M. Simanyi 1, W. Danielczyk 11L. Boltzmann Institute for Aging Research (Working Group: Alzheimer-Dementia Research) Neurological Department, Geriatric Hospital Lainz, 2Neurologic Clinic, Vienna Medical School, 3Psychiatric Clinic, Vienna Medical School

The symptom complex of finger anomia, right-left disorientation, dysgraphia, and dyscalculia constitutes Gerstmann’s syndrome. It is mostly described in adults and is caused by acquired lesions of the dominant parietal lobe. It is infrequently described in children with learning disabilities and has been designated developmental Gerstmann’s syndrome. Developmental Gerstmann’s syndrome goes unnoticed if not specifically sought by clinicians. A detailed evaluation will reveal subtle neurologic deficits, behavioral problems, and neuropsychologic and specific speech and language abnormalities. Ten such patients are reported; six of the children demonstrated improvement with intensive speech training. Early identification and intervention is therefore crucial, and even more important in cultures in which students are required to be biliterate or triliterate, further increasing the constraints on writing. A selective writing, reading, or calculation abnormality in the presence of normal oral communication triggers several interesting possibilities for the brain mechanisms behind normal language processing. Similarly, the association of acalculia with finger anomia and agraphia with right-left disorientation may have specific implications in the neuropsychologic processing of the evolution of calculation and writing. A theoretical possibility of oral and written language processing from the observation of the language behavior of these children is also described.

Reversed laterality of cerebral functions in a non-right-hander: Neuropsychological and spect findings in a case of ‘atypical’ dominance

A 54-year-old-non-right-handed man with positive familial sinistrality showed a pure right hemisphere syndrome following a left hemisphere stroke. Severe right side hemineglect, transcortical motor dysprosodia, spatial dysgraphia and visuo-constructive impairments were observed. At no time were the expected left hemisphere abnormalities such as aphasia, alexia, right-left disorientation or finger agnosia noted. A left fronto-temporal subcortical lesion was documented on CT scan. A Tc-99m HM-PAO SPECT study revealed no cerebral blood flow changes in the right hemisphere while in the left hemisphere a fronto-temporo-parietal cerebral blood flow reduction was evident. This case of a complete reversed laterality of cognitive functions argues for a distinction ‘anomalous’ cerebral dominance and ‘atypical’ cerebral dominance.

Parkinsonismo associado a tumor cerebral relato de caso

Descreve-se o caso de paciente com síndrome parkinsoniana à direita, associada a disfunções cognitivas e síndrome de hipertensão intracraniana. A tomografia de crânio e o estudo angiográfico de vasos intracranianos demonstraram a presença de volumoso processo expansivo fronto-temporal esquerdo. A eletromiografia revelou tremor de repouso com frequência de 4 a 6 ciclos por segundo. A paciente foi submetida a ressecção cirúrgica da massa tumoral, cujo exame histológico revelou tratar-se de meningioma. A evolução pós-operatória foi excelente e após dois meses todas as anormalidades neurológicas haviam desaparecido. Um ano após a remoção do tumor a paciente permanecia assintomática sem uso de qualquer medicação. São discutidos aspectos fisiopatológicos do parkinsonismo por processo expansivo e as particularidades do presente caso são analisadas em confronto a dados da literatura.

Right Parietal Stroke With Gerstmann's Syndrome

We examined a patient who exhibited Gerstmann's syndrome (left-right disorientation, finger agnosia, dyscalculia, and dysgraphia) in association with a perioperative stroke in the right parietal lobe. This is the first description of the Gerstmann tetrad occurring in the setting of discrete right hemisphere pathologic findings. A well-localized vascular lesion was demonstrated by computed tomography, magnetic resonance imaging, and single-photon emission computed tomographic studies. The patient had clinical evidence of reversed functional cerebral dominance and radiologic evidence of reversed anatomic cerebral asymmetries.

A SPECIFIC DEFICIT FOR NUMBERS IN A CASE OF DENSE ACALCULIA

In this study we investigated the acalculic condition of a patient, C.G., with the classical signs of Gerstmann's Syndrome: finger agnosia; right-left disorientation; a profound agraphia (but with an equally profound alexia) and a remarkably dense acalculia. Using a series of number processing and number knowledge tasks, a selective impairment for numbers was demonstrated. Within the category of numbers C.G. showed a largely preserved ability to deal with numbers below 4, in all tasks and in all modalities, while she was totally unable to deal with numbers above 4. The consistency of responses and the ineffectiveness of cueing indicated that numbers above 4 were lost, rather than hard to access. Further testing showed that this impairment did not result from a more general semantic memory problem, a difficulty in understanding quantities or a deficit in reasoning abilities thought to underlie the concept of numbers. Difficulty with some other ordinal structures was also present, but appeared unrelated to those affecting numbers.

Gerstmann Syndrome: A Case Report

A case of Gerstmann syndrome following a trauma is presented. After one month the patient showed the four symptoms of the Gerstmann syndrome associated with slight visual memory and constructional praxis deficits. Eight months later, however, he showed only dyscalculia, dysgraphia, right-left disorientation and finger agnosia, in accordance with selective damage of the left angular gyrus revealed by CT scan.The findings seems to support the existence and the localizing value of Gerstmann syndrome.

Gerstmann tetrad in Leopard syndrome

We report a 12-year-old boy with multiple lentigines (Leopard) syndrome who was evaluated for learning difficulties and Gerstmann tetrad syndrome (i.e., dyscalculia, left-right disorientation, finger agnosia, and dysgraphia). Cranial computed tomography revealed left ventriculomegaly, more pronounced in the occipital horn suggesting mild atrophy of the left parietal lobe. This is the first report of an association between the Leopard and Gerstmann syndromes and one of the few to demonstrate a computed tomographic abnormality in the latter.

Agrammatism and conduction aphasia: A chinese case

A 60-year-old right-handed Chinese man was well until one week prior to admission because his family noted that he seemed “confused.” Upon examination, we observed that he slurred his speech and that while he could recognize some familiar things he lost his ability to calculate. There was no motor impairment physically nor was there any sensory loss, other than his speech problem. We thus conducted a series of neuropsychological tests for the purpose of our neurolinguistic investigation. The results were that repetition was fluent but paraphasic and that his natural speech was fluent but he was poor in naming. Also noted were severe agraphia, finger agnosia, acalculia, and left-right disorientation. Neurological examination was otherwise normal. But the CT scan of the brain revealed a left parieto-occipital infarction. This case was therefore diagnosed as conduction aphasia. Of his various deficits one stands out distinctly, which is agrammatisam. However, this patient's agrammatism differs considerably from that reported in the two cases of transcortical aphasia. This presentation will focus on such features of agrammatism as may be observed in our patient, although we cannot say that his agrammatism is typical of conduction aphasia among the Chinese patients because this is the first case ever reported; there are no other case reports in the literature with which to compare.

“Psychometric” Assessment During Transient global Amnesia

A Patient “psychometrically” assessed during an attack of transient global amnesia showed total inability to form new long term memories but normal immediate recall. There was nearly perfect preservation of other psychological functions with good recall of distant events and no dysphasia, dyslexia, dysgraphia, dysphaxia, right-left disorientation, constructional apraxia or visual agnosia. Calculation was probably also normal. Some of the 5 previously reported patients, who have been similarly studied during attacks of transient global amnesia, showed evidence of damage to the brain beyond the hippocampal forniceal system. The present patient demonstrates the market selectivity of memory disturbance in “pure transient global amnesia”.

Left-right confusion and the perception of bilateral symmetry.

The present study investigates the relationship between the perception of bilateral symmetry and left-right disorientation in neurologically-intact adults. Using tachistoscopic presentation of stimuli and a choice reaction-time procedure, we found a small but consistent trend toward quicker symmetry judgements in left-right confused subjects. Possible neuropsychological mechanisms underlying this curious finding are discussed.

Recovery Processes of Three Aphasic Patients with“Gerstmann Syndrome”

A retrospective investigation was made on the recovery processes of three adult aphasic patients with “Gerstmann Syndrome” and other neuropsychological deficits. The period of study covered in each case was 18 months starting from one to two months post onset of illness. The major findings can be summarized as follows;1. At the initial examination, the nature and severity of the four Gerstmann deficits (an aggregate of finger agnosia, right-left disorientation, agraphia and acalculia) varied from case to case. In addition, some other neuropsychological deficits (such as constructional apraxia, spatial disorientation and/or impairment of topographical memory and time orientation) were found in each case.2. The prognosis of the four Gerstmann deficits differed from patient to patient. In one patient the recovery process was so good as to obtain the premorbid level, whereas in the others a fair improvement was made in finger localization, writing and calculation, but not in right-left discrimination.3. The sites of the brain lesions confirmed by the CT scan in the three patients varied widely, i. e., bilateral and left parietal with ventricular dilatation in the first patient, left parietal in the second, and right frontal subcortical with lesion of the putamen in the third who was left handed.On the basis of these findings, it was tentatively concluded that no specific neuropsycho-logical significance could be attached to the grouping of the four Gerstmann deficits.

Sinistrad Mirror Writing and Reading After Brain Concussion in a Bi-Systemic (Oriento-Occidental) Polyglot

The problem of mirror writing and reading is discussed in the light of a clinical case, where this disturbance appeared after an apparently minor head injury. Mirror writing and reading in this polyglot individual affected only the sinistrad (Hebrew) writing and reading system, leaving the dextrad (Latin) system unimpaired. This disturbance appeared together with dyscalculia, left-right disorientation and slight temporal confusion, suggestive of parieto-occipital lobe pathology. The clinical picture also showed apparently "conversional" traits, such as are sometimes seen in incomplete parietal lobe syndromes. The relevant literature is reviewed and patho-physiological mechanisms of mirror reversal are discussed.

The Concept of the Body Schema: A Critical Review and Some Experimental Results

The concept of the body schema is widely used, in clinical neurology and in neuropsychological research, to explain a great variety of disturbances. A historical review demonstrates that the classical authors have by no means developed an unequivocal, let alone unitary concept. Subsequent use and misuse has virtually emptied the theoretical construct of its previous meaning. The most important clinical signs and symptoms which are termed “disturbances of the body schema” are discussed in detail, on the basis of experimental results. Neither autotopagnosia, nor finger agnosia, nor “right-left disorientation” are unitary in nature. All of these disturbances appear in various types, brought about by varying underlying neuropsychological deficit, such as aphasia, spatial disorientation or general mental disorder.

Effect of parietal lobe damage on the performance of reversible operations in space

Patients with cerebral damage were tested on three tasks requiring the performance of reversible operations in space. Damage to either the right or the left parietal lobes resulted in impairments on all three tasks; lesions in other cortical areas resulted in slight, if any, deficits. It is suggested that the inability to assume different perspectives in imagery underlies many of the impairments associated with parietal lobe damage, such as constructional apraxia and right-left disorientation.

The orienting response as a nonverbal measure of neurological extinction.

Detection and localization of tactile stimulation in neurological patients is typically evaluated through verbal report. This approach is limited, especially in evaluating perceptual distortions, some of which may have a primarily psychological rather than physiological explanation. An alternative approach, based on the orienting response as measured by the galvanic skin response (GSR), was evaluated for its equivalence to verbal report. Its efficacy was explored in measuring face-hand extinction in which sensation on the hand is masked when face and hand are touched simultaneously. The GSR to single stimulations of the cheek was habituated and then simultaneous stimulation of the cheek and hand was given. Ss were dichotomized on the basis of their verbal report as to whether they reported feeling the touch on the hand. The 12 Ss reporting only face stimulation (extinction), showed no new orienting response, but a large response was evoked in 12 Ss reporting both touches. This measure might provide basic insight into paradoxical clinical phenomena such as hysterical anesthesia, allesthesia, and unilateral right-left disorientation.

Turner's syndrome and Gerstmann's syndrome: Neuropsychologic comparisons

Gerstmann-syndrome symptoms were assessed in patients with Turner's syndrome. Finger agnosia and dysgraphia did not occur. There was a mild dyscalculia, and a more severe right-left disorientation limited to extrapersonal space. Constructional apraxia and visual-spatial disorientation, symptoms sometimes associated with Gerstmann's syndrome, were typically present. The underlying common deficit appears to be a dysgnosia for extrapersonal spatial relations and for form perception. It is suggested that patients with Turner's syndrome may have a mild and variable developmental defect in the parietal functions of the cortex, possibly determined by the cytogenetic defect characteristic of the syndrome or by some neurohormonal deficit secondary to it.

The developmental Gerstmann syndrome.

The Gerstmann syndrome 7 (finger agnosia, right-left disorientation, dysgraphia, and dyscalculia) has long been recognized as indicative of disease of the parietal lobe of the dominant hemisphere and appears to be due to impairment of a basic physiological function involving sequential ordering. 13,14 The question arises as to whether this syndrome may appear in children on a developmental basis, and if so, what effect it has on their acquisition of educational skills. It therefore becomes important to establish diagnostic criteria for the syndrome in children. The problem revolves around the definition of finger agnosia in childhood. Finger agnosia, as conventionally elicited, 7 is difficult to diagnose in childhood. Normal children are not necessarily able to name their fingers, and failure on an unstandardized task involving the names of the fingers is of doubtful significance. As the presence of finger agnosia is essential to the diagnosis of the Gerstmann syndrome, this

Parietal Lesion and "Enavid."

This letter reports the case of a 41-year-old woman who had taken 4 tablets daily of 5-mg norethynodrel (Enavid) for menstrual pain over a 3-month period; she was admitted to an English hospital because of difficulty in finding words and headache. General examination showed that x-rays blood count and heart and lung sounds were normal; she had a nominal aphasia dysgraphia and dyslexia and there was some right-left disorientation and finger agnosia. The diagnosis was left parietal lesion probably due to cortical venous thrombosis. Enavid was stopped and the dysmenorrhoea returned. She improved considerably in terms of speech writing and reading but considerable residual disability remained and some may be permanent.