Dyscalculia, Dysgraphia, and Left-Right Confusion from a Left Posterior Peri-Insular Infarct

• Published in: Behavioural neurology Vol. 2014; no. 2014; pp. 1 - 4
• Main Authors: Bhattacharyya, S., Cai, X., Klein, J. P.
• Format: Journal Article
• Language: English
• Published: Cairo, Egypt Hindawi Puplishing Corporation 01-01-2014; Hindawi Publishing Corporation; Hindawi Limited
• Subjects: Aged; Agraphia - etiology; Agraphia - pathology; Agraphia - psychology; Brain Infarction - complications; Brain Infarction - pathology; Brain Infarction - psychology; Case Report; Dyscalculia - etiology; Dyscalculia - pathology; Dyscalculia - psychology; Female; Functional Laterality - physiology; Humans; Magnetic Resonance Imaging; Parietal Lobe - pathology; Perceptual Disorders - etiology; Perceptual Disorders - pathology; Perceptual Disorders - psychology; Space Perception - physiology; Temporal Lobe - pathology
• ISSN: 0953-4180; 1875-8584
• DOI: 10.1155/2014/823591

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.