Gerstmann Syndrome as the Sole Clinical Manifestation of Ischemic Stroke Secondary to Atrial Fibrillation: A Case Report

Gerstmann syndrome (GS) is a rare neurological disorder characterized by the presence of agraphia, acalculia, right-left disorientation, and finger agnosia. In older adults, the isolated presentation of this syndrome may represent an early sign of an ischemic cerebrovascular event, particularly in patients who have cardioembolic risk factors such as atrial fibrillation (AF). We report the case of a 72-year-old male with a history of hypertension, type 2 diabetes, AF without anticoagulant treatment, and chronic alcohol use who presented with a five-day history of behavioral changes and difficulty communicating. The patient's symptoms were initially attributed to hepatic encephalopathy or possible alcohol poisoning. However, a detailed neurological examination revealed dysgraphia, acalculia, right-left disorientation, and finger agnosia. Cranial magnetic resonance imaging subsequently confirmed a multifocal ischemic lesion in the left temporal and right temporoparietal lobes, establishing a diagnosis of GS secondary to ischemic stroke. This report highlights the importance of early recognition of rare focal neurocognitive syndromes as the sole presentation of cerebrovascular events.