Background
Left-right disorientation is most often associated with Gerstmann’s syndrome, a syndrome caused by damage to the dominant parietal lobe which presents with a tetrad of symptoms including left-right disorientation, acalculia, agraphia, and finger agnosia. This disorder is most often caused by a stroke but is also rarely associated with brain tumors and subdural hematomas. There are currently only 4 cases reported in the literature of seizures presenting with Gerstmann’s symptoms.

Case Presentation
A 60-year-old man presented to our neurology office with frequent episodes of decreased awareness and shock-like sensations in his hands and feet. His evaluation showed no major abnormalities including a normal electroencephalogram and magnetic resonance imaging of the brain. He was started on levetiracetam for presumed complex partial seizures. He experienced no further seizure episodes thereafter. During a follow-up visit, he reported new historical details not previously disclosed: since childhood, he had difficulty differentiating between left and right. These symptoms had caused significant difficulties for him throughout his life, leading to special tutoring in elementary school, and trouble learning to drive. He often had to use external cues such as looking at the watch on his left hand to determine left and right. He reported that after starting levetiracetam he became hyperaware of directionality and even felt that his visual field was labeled with “left” and “right”. His left-right confusion had seemed to completely and permanently abate. 

Discussion
The resolution of this patient’s left-right confusion with levetiracetam was dramatic and unexpected. We question whether his left-right disorientation may have been related to underlying seizure activity in the parietal lobe as has been described rarely in the literature. However, the persistence of his left-right disorientation throughout life, even when not actively seizing, is puzzling and would represent a presentation unique from anything currently in the literature. 


Lifelong Left-Right Disorientation that Resolved with Anti-Epileptic Therapy

Clinical Vignettes | Neurology

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Lifelong Left-Right Disorientation that Resolved with Anti-Epileptic Therapy

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