A disconnection account of Gerstmann syndrome: functional neuroanatomy evidence

Elena Rusconi, Philippe Pinel, Evelyn Eger, Denis LeBihan, Bertrand Thirion, Stanislas Dehaene, Andreas Kleinschmidt

Research output: Contribution to journalArticle

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Abstract

To examine the functional neuroanatomy that could account for pure Gerstmann syndrome, which is the selective association of acalculia, finger agnosia, left-right disorientation, and agraphia. We used structural and functional neuroimaging at high spatial resolution in healthy subjects to seek a shared cortical substrate of the Grundstörung posited by Gerstmann, ie, a common functional denominator accounting for this clinical tetrad. We construed a functional activation paradigm that mirrors each of the four clinical deficits in Gerstmann syndrome and determined cortical activation patterns. We then applied fiber tracking to diffusion tensor images and used cortical activation foci in the four functional domains as seed regions. None of the subjects showed parietal overlap of cortical activation patterns from the four cognitive domains. In every subject, however, the parietal activation patterns across all four domains consistently connected to a small region of subcortical parietal white matter at a location that is congruent with the lesion in a well-documented case of pure Gerstmann syndrome. Our functional neuroimaging findings are not in agreement with Gerstmann's postulate of damage to a common cognitive function underpinning clinical semiology. Our evidence from intact functional neuroanatomy suggests that pure forms of Gerstmann's tetrad do not arise from lesion to a shared cortical substrate but from intraparietal disconnection after damage to a focal region of subcortical white matter.
Original languageEnglish
Pages (from-to)654-662
Number of pages9
JournalAnnals of Neurology
Volume66
Issue number5
DOIs
Publication statusPublished - Nov 2009

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Gerstmann Syndrome
Neuroanatomy
Functional Neuroimaging
Dyscalculia
Agraphia
Agnosia
Confusion
Parietal Lobe
Cognition
Seeds
Healthy Volunteers
White Matter

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Rusconi, E., Pinel, P., Eger, E., LeBihan, D., Thirion, B., Dehaene, S., & Kleinschmidt, A. (2009). A disconnection account of Gerstmann syndrome: functional neuroanatomy evidence. Annals of Neurology, 66(5), 654-662. https://doi.org/10.1002/ana.21776
Rusconi, Elena ; Pinel, Philippe ; Eger, Evelyn ; LeBihan, Denis ; Thirion, Bertrand ; Dehaene, Stanislas ; Kleinschmidt, Andreas. / A disconnection account of Gerstmann syndrome : functional neuroanatomy evidence. In: Annals of Neurology. 2009 ; Vol. 66, No. 5. pp. 654-662.
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Rusconi, E, Pinel, P, Eger, E, LeBihan, D, Thirion, B, Dehaene, S & Kleinschmidt, A 2009, 'A disconnection account of Gerstmann syndrome: functional neuroanatomy evidence', Annals of Neurology, vol. 66, no. 5, pp. 654-662. https://doi.org/10.1002/ana.21776

A disconnection account of Gerstmann syndrome : functional neuroanatomy evidence. / Rusconi, Elena; Pinel, Philippe; Eger, Evelyn; LeBihan, Denis; Thirion, Bertrand; Dehaene, Stanislas; Kleinschmidt, Andreas.

In: Annals of Neurology, Vol. 66, No. 5, 11.2009, p. 654-662.

Research output: Contribution to journalArticle

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AU - Rusconi, Elena

AU - Pinel, Philippe

AU - Eger, Evelyn

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AU - Thirion, Bertrand

AU - Dehaene, Stanislas

AU - Kleinschmidt, Andreas

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Rusconi E, Pinel P, Eger E, LeBihan D, Thirion B, Dehaene S et al. A disconnection account of Gerstmann syndrome: functional neuroanatomy evidence. Annals of Neurology. 2009 Nov;66(5):654-662. https://doi.org/10.1002/ana.21776