Abstract
A 65 year-old right-handed patient was admitted to our hospital for treatment of right-sided hemiparesis and speech disturbance 14 days after onset. He had been taking antihyper-tensive drugs. Neurological examinations at admission revealed slight right hemiparesis, mild trans-cortical sensory aphasia and a tetrad of Gerstmann's syndrome as examined by verbal and non-verbal methods. The aphasia and hemiparesis were almost fully cured at two months after onset, but the tetrad of Gerstmann's syndrome (agraphia, acalculia, right and left agnosia, finger agnosia) was still observed. Xray-CT showed left thalamic hemorrhage, and MRI in the chronic stage revealed a localized high intensity area in the left thalamus (Fig. 3). IMP-SPECT showed an extensive decrease (10˜20%) of cerebral blood flow in the left hemisphere including the angular gylus (Fig. 4). The Gerstmann's syndrome almost disappeared 4 months after onset. In this case, Gerstmann's syndrome occurred from subcortical lesion localized in the left thalamus. But the SPECT showed extensive low perfusion in the left hemisphere. These findings suggested that Gerstmann's syndrome nay occur due to functional damage of the thalamo-cortical ascending pathway. Only two cases of Gerstmann's syndrome traced to thalamic hemorrhage have been reported.
