There are few things more frustrating than being handed a neurology case on rounds, and realizing it’s one of those “cortical syndromes” that make your brain sweat harder than your patient’s. Gerstmann Syndrome is one of those oddly specific cortical syndromes that you either remember from med school or panic-Google mid-round.
Let’s make it stick this time—with the nifty mnemonic: A-ALF.
It sounds like the name of a top-secret brainwave frequency—or maybe a sci-fi robot—but trust me, A-ALF holds the key to remembering the core four features of Gerstmann Syndrome.
🧠 Mnemonic: “A-ALF”
| Letter | Feature | Explanation |
|---|---|---|
| A | Agraphia | Inability to write (not just bad handwriting—we’re talking full-on dysfunction)✍️ |
| A | Acalculia | Impaired ability to perform basic arithmetic—even 2+2 can become rocket science 🔢 |
| L | Left–right disorientation | Confusing left from right—so don’t ask these patients for directions 🧭 |
| F | Finger agnosia | Inability to identify fingers on command—it’s not just laziness, it’s cortical!☝️ |
🏥 A Case from Awaran
I remember seeing a middle-aged schoolteacher from Awaran who came in after what seemed like a minor stroke. She was sharp, eloquent—but suddenly couldn’t write, couldn’t solve basic math, and when I asked her to lift her left index finger, she looked like I had just asked her to lift a ghost. 👻
Dr. Basit Khan and I had a “eureka moment” when we saw her brain MRI: lesion in the dominant inferior parietal lobule, specifically the angular gyrus. Classic Gerstmann.
She was relieved it had a name—and no, she didn’t appreciate the joke when I told her she had “A-ALF syndrome.” (I did.)
