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Behavioural Neurology
Volume 2014, Article ID 823591, 4 pages
Case Report

Dyscalculia, Dysgraphia, and Left-Right Confusion from a Left Posterior Peri-Insular Infarct

S. Bhattacharyya,1,2,3 X. Cai,1,2,3 and J. P. Klein1,3,4

1Department of Neurology, Brigham and Women’s Hospital, 45 Francis Street, Boston, MA 02115, USA
2Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
3Harvard Medical School, Boston, MA 02115, USA
4Department of Radiology, Brigham and Women’s Hospital, Boston, MA 02115, USA

Received 25 October 2013; Accepted 5 December 2013; Published 10 April 2014

Academic Editor: A. E. Hillis

Copyright © 2014 S. Bhattacharyya et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The Gerstmann syndrome of dyscalculia, dysgraphia, left-right confusion, and finger agnosia is generally attributed to lesions near the angular gyrus of the dominant hemisphere. A 68-year-old right-handed woman presented with sudden difficulty completing a Sudoku grid and was found to have dyscalculia, dysgraphia, and left-right confusion. Magnetic resonance imaging (MRI) showed a focus of abnormal reduced diffusivity in the left posterior insula and temporoparietal operculum consistent with acute infarct. Gerstmann syndrome from an insular or peri-insular lesion has not been described in the literature previously. Pathological and functional imaging studies show connections between left posterior insular region and inferior parietal lobe. We postulate that the insula and operculum lesion disrupted key functional networks resulting in a pseudoparietal presentation.