Gerstmann Syndrome: A Rare Clinical Presentation of Focal Hyperglycemic Seizures

Hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is a complication of type 2 diabetes mellitus that can progress to coma and death if left untreated. Focal hyperglycemic seizures are still an uncommon but noteworthy association of HHNS and most commonly involve the occipital and parietal lobes. Gerstmann syndrome, also called angular gyrus syndrome, consists of a tetrad of finger agnosia, acalculia, left-right disorientation, and agraphia that is usually accompanied by aphasia and most commonly presents in parietal lobe pathology. Here we report a case of a 50-year-old right-handed male with complaints of focal right-sided upper limb and facial seizures and findings of acalculia, finger agnosia, left-right disorientation, semantic aphasia, and loss of comprehension. Laboratory reports suggested HHNS seizures that presented clinically as Gerstmann syndrome. Magnetic resonance imaging (MRI) of the brain revealed dominant (left in our case) parietal lobe pathology. Although it is understood that HHNS is linked with focal neurological deficits, the exact mechanism by which this happens is still unknown, and Gerstmann syndrome associated with hyperglycemic seizures is still underreported, necessitating additional research.