A pure case of Gerstmann syndrome with a subangular lesion

The four symptoms composing Gerstmann's syndrome were postulated to result from a common cognitive denominator (Grundstörung) by Gerstmann himself. He suggested that it is a disorder of the body schema restricted to the hand and fingers. The existence of a Grundstörung has since been contested. Here we suggest that a common psychoneurological factor does exist, but should be related to transformations of mental images rather than to the body schema. A patient (H.P.) was studied, who presented the four symptoms of Gerstmann's syndrome in the absence of any other neuropsychological disorders. MRI showed a focal ischaemic lesion, situated subcortically in the inferior part of the left angular gyrus and reaching the superior posterior region of T1. The cortical layers were spared and the lesion was seen to extend to the callosal fibres. On the basis of an extensive cognitive investigation, language, praxis, memory and intelligence disorders were excluded. The four remaining symptoms (finger agnosia, agraphia, right-left disorientation and dyscalculia) were investigated thoroughly with the aim of determining any characteristics that they might share. Detailed analyses of the tetrad showed that the impairment was consistently attributable to disorders of a spatial nature. Furthermore, cognitive tests necessitating mental rotation were equally shown to be impaired, confirming the essentially visuospatial origin of the disturbance. In the light of this report, the common cognitive denominator is hypothesized to be an impairment in mental manipulation of images and not in body schem

Hearing of a presence

Here we describe a patient with epilepsy (secondary to left parieto-temporal brain damage) suffering from the paroxysmal unilateral experience of hearing a person in her near extrapersonal space. The paroxysmal auditory experience was associated with a deficit in spatial auditory perception and other paroxysmal disorders of somatognosia. Based on these findings, it is suggested that the paroxysmal hearing of a person nearby corresponds to an auditory disorder of somatognosia

Letters lost in space: hemispace dependent handwriting errors

Although handwriting is a daily life activity commonly attributed to the left hemisphere in the majority of right-handers, it is also known to require attentional and spatial mechanisms that rely on right hemispheric processing. The underlying spatial organization of handwriting in patients with right brain damage remains unresolved. Here we show in a patient with circumscribed right superior parietal damage that handwriting systematically depends on the hand's position in space with respect to her body-midline. Most importantly, handwriting in contralesional space not only leads to spatial but also to language errors. This suggests that the right hemisphere's role in handwriting may surpass its generally assumed purely spatial contribution. We discuss our results in term of co-registration between both cerebral hemispheres in language processing

Writing without Graphic Motor Patterns: A Case of Dysgraphia for Letters and Digits Sparing Shorthand Writing

Thi s pape r report s th e cas e of a patien t (H P) wh o present s a dysgraphi a affectin g th e productio n of letter s an d digit s whil e sparin g shorthan d writing . H P' s writin g impairmen t is two-fold . O n on e hand , HP produce s systemati c lette r substitution s affectin g exclusivel y lower-cas e letter s b , p , d , and q . Suc h confusion s ar e als o observe d in task s assessin g th e menta l imager y of letter s an d th e processin g of visuall y presented , isolate d letters . Thi s defici t is attribute d to a circumscribe d disruptio n of allographi c representa tions . On th e othe r hand , H P ca n writ e correctl y forme d letter s an d digit s bu t th e productio n of thes e symbol s is slo w an d nonfluent . Thi s disturbanc e wa s investigate d by usin g a digitisin g table t to recor d movement s performe d in grapho-moto r production . Th e result s of th e analysi s of tempora l an d kinemati c indice s sugges t tha t graphi c moto r pattern s of letter s an d digit s ar e no longe r availabl e to thi s patient , wherea s moto r pattern s underlyin g th e productio n of shorthan d see m unaffected . It is suggeste d tha t ther e ar e tw o way s fo r producin g spatiall y well-forme d symbols . O ne rout e is mediate d by graphi c motor pattern s an d th e other by a motor planning syste m tha t woul d be use d in othe r tasks involvin g the generatio n of 2D trajectorie s (a s in drawin g or in tracing unfamilia r symbols)

Assessment of Social Cognition and Theory of Mind: Initial Validation of the Geneva Social Cognition Scale

Social cognition is widely studied in neurology. At present, such evaluations are designed for research or for specific diseases and simple general clinical tools are lacking. We propose a clinical evaluation tool for social cognition, the Geneva Social Cognition Scale (GeSoCS)

Language and syntactic impairment following stroke in late bilingual aphasics.

PURPOSE: Bilingual aphasia generally affects both languages. However, the age of acquisition of the second language (L2) seems to play a role in the anatomo-functional correlation of the syntactical/grammatical processes, thus potentially influencing the L2 syntactic impairment following a stroke. The present study aims to analyze the influence of late age of acquisition of the L2 on syntactic impairment in bilingual aphasic patients. METHODS: Twelve late bilingual participants (speaking French as L2 and either English, German, Italian or Spanish as L1) with stroke-induced aphasia participated in the study. The MAST or BAT aphasia batteries were used to evaluate overall aphasia score. An auditory syntactic judgement task was developed and used to test participants syntactic performance. RESULTS: The overall aphasia scores did not differ between L1 and L2. In a multiple case analysis, only one patient had lower scores in L2. However, four patients presented significantly lower performances in syntactic processing in the late L2 than in their native language (L1). In these four patients the infarct was localized, either exclusively or at least partially, in the pre-rolandic region. CONCLUSION: This pilot study suggests that, in late bilingual aphasics, syntactic judgment abilities may be more severely impaired in L2, and that this syntactic deficit is most likely to occur following anterior lesions