Dados do Trabalho

Título

The functional impairment of Gerstmann syndrome after a subacute stroke: a case report.

RESUMO

Case: Female patient, 42 years old, incomplete elementary school, black, obese, with hypertension, type 2 diabetes mellitus and depression. Family history of cardiovascular disease, father with a history of 5 previous ischemic events and deceased from acute myocardial infarction. Followed up at the neurology outpatient clinic due to sequelae of ischemic stroke. She presented the onset of focal symptoms with right hemiparesis, memory loss and dysarthria, however, she was managed as an anxiety crisis in the emergency room. After 3 months, she presented with a sudden severe headache, which was then referred to the tertiary center for imaging tests. Cranial computed tomography showed a hypodense cortical lesion in the frontal and left parietal lobes. Cranial magnetic resonance angiography showed signs of ischemia in the left perirolacnic cortex. The two ischemic events had an atheroembolic origin. The patient has a deficit in spatial and semantic memory and impairment in instrumental activities of daily living. For functional rehabilitation, she was referred to our institution. On physical examination, patients scored 18 points on the Mini Mental State Examination, with acalculia, agraphia, digital agnosia and right-left disorientation, characteristic findings of Gerstmann Syndrome. In the somatic examination, homonymous hemianopia on the right and paresis in the right lower limb grade IV were observed.
Discussion: Gerstmann Syndrome is characterized by digital agnosia, right-left disorientation, dysgraphia and acalculia and its development can be caused by different etiologies, such as neoplasms or stroke. The presence of the symptom tetrad of this condition is rare, so having all the associated symptoms is not necessary for the diagnosis. It is noteworthy the persistence of the patient's functional disability, mainly related to cognitive functions, even after the work of the multidisciplinary team for her rehabilitation and motor improvement.
Final comments: Recognition of this syndrome is essential to understand which cognitive deficits are impacting the patient's functionality and to design a better rehabilitation strategy.

Palavras Chave

Cerebrovascular disease, subacute stroke, Gerstmann syndrome