Atypical Presentation of Gerstmann Syndrome in a Patient with Encapsulated Right Chronic Subdural Hematoma

Gerstmann syndrome, occasionally dubbed the angular gyrus syndrome is a constellation of clinical features that depict a potential inherent problem affecting the supramarginal and angular gyrus of the dominant left parietal cortex resulting in a partial or full complement of a tetrad of symptoms. It is a syndrome that depicts a derangement in key functions of the parietal lobe of the dominant hemisphere which is the left cerebral cortex in most people. Its cause can arise from a myriad of traumatic, vascular, tumoral, metabolic or infectious cerebral aetiologies. Chronic subdural hematoma is a common condition prevalent in the elderly population and managed by neurosurgeons worldwide. Its pathophysiology involves elaboration of fibrin degradation products, liquefaction of blood clots and new membrane formation due to fibroblast activity on a subdural hematoma over a period of time which warrants surgical treatment to ameliorate clinical features attributable to it. This article highlights the management of a relatively rare case in which features of Gerstmann syndrome were noted in a patient who had radiologic evidence of chronic subdural hematoma in the right non dominant hemisphere, bringing to the fore the importance of detailed neurologic evaluation of patients with parietal lobe lesions in either hemispheres for features of Gerstmann syndrome in order to avoid incidence of missed diagnosis which may influence holistic management of patients presenting symptom and reflect as suboptimal outcome following treatment.