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personal space as a result of damage to one (the dominant) hemisphere More recent observations indicate that patients with right parietal lesions show variable but lesser elements of ipsilateral neglect in addition to the striking degree of contralateral neglect, suggesting that, in respect to spatial attention, the right parietal lobe is truly dominant (Weintraub and Mesulam) A clever observation of Bisiach and Luzzatti has suggested that the loss of attention to one side of the environment extends to the mental representation of space Their patient with a right parietal lesion was asked to describe from memory the buildings lining the Piazza del Duomo, rst as if seen from one corner of the piazza and then from the opposite corner In each instance the description omitted the left side of the piazza from the observer s perspective This has similarities to the topographagnosia described further on Perhaps another aspect of parietal lobe physiology, revealed by human disease, is the loss of exploratory and orienting behavior with the contralateral arm and even a tendency to avoid tactile stimuli Mori and Yamadori call this rejection behavior DennyBrown and Chambers attribute the released grasping and exploring that follow frontal lobe lesions to a disinhibition of inherent parietal lobe automatisms, but we have no way of con rming this It is of interest that demented patients with prominent grasp re exes tend not to grasp parts of their own bodies unless there has been a parietal lesion, in which case there may be self-grasping of the forearm opposite the lesion (Ropper) Conventional treatments for hemispatial neglect use prismatic glasses and training in visual exploration of the left side Of some interest has been an approach that demonstrates improvement by the application of vibratory stimulation to the right side of the neck as reported by Karnath and colleagues or of the ipsilateral labyrinth by caloric or electrical means (a similar treatment has been successful in some cases of dystonic torticollis, see Chap 6) Gerstmann Syndrome This syndrome provides the most striking example of what might be viewed as a bilateral asomatognosia and is due to a left or dominant parietal lesion The characteristic features are inability to designate or name the different ngers of the two hands ( nger agnosia), confusion of the right and left sides of the body, and inability to calculate (dyscalculia) and to write (dysgraphia) One or more of these manifestations may be associated with word-blindness (alexia) and homonymous hemianopia or a lower quadrantanopia, of which the patient is usually unaware The lesion is in the inferior parietal lobule (below the interparietal sulcus), particularly the angular gyrus or subjacent white matter of the left hemisphere There has been a dispute as to whether the four main elements of the Gerstmann syndrome have a common basis or only an association Benton states that they occur together in a parietal lesion no more often than do constructional apraxia, alexia, and loss of visual memory and that every combination of these symptoms and those of the Gerstmann syndrome occurs with equal frequency in parietal lobe disease Others, including the authors, tend to disagree and believe that right-left confusion, digital agnosia, agraphia, and acalculia have special signi cance, possibly being linked through a unitary defect in spatial orientation of ngers, body sides, and numbers The relationship between the ngers and the ability to enumerate is especially intriguing and relates to other arithmetic dif culties, discussed below Dyscalculia has attracted little critical attention, perhaps because it occurs most often as a by-product of aphasia and an inability of the patient to appreciate numerical language Primary.

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