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Stereognosis
John B. Irving
B.Sc.
Abstract
A dissertation read before the Royal Medical Society on Friday, February 2nd, 1968.
Stereognosis may be defined as the ability to recognise objects using only tactile (somatic) sensation. The
ability is best developed in blind people and depends on memory and on an intact somatic sensory system.
Loss of this ability, astereognosis, is usually considered as a defect in somatic sensation. A native of New
Guinea, although he might be unable to recognise the objects commonly used to test for stereognosis, would
not deserve to be given the diagnosis of a cortical lesion. His failure is a failure of learning. Patients suffering
from dementia may show astereognosis as a consequence of a general deterioration in mental function.
Learning and memory therefore play an important part in stereognosis, but in clinical practice and in
physiology, more interest is taken in the function of the somatic sensory system.
Copyright Royal Medical Society. All rights reserved. The copyright is retained by the author and the Royal Medical Society, except
where explicitly otherwise stated. Scans have been produced by the Digital Imaging Unit at Edinburgh University Library. Res Medica is
supported by the University of Edinburghs Journal Hosting Service: http://journals.ed.ac.uk
ISSN: 2051-7580 (Online) ISSN: 0482-3206 (Print)
Res Medica is published by the Royal Medical Society, 5/5 Bristo Square, Edinburgh, EH8 9AL
Res Medica, Summer 1968, 6(2): 23, 25-27
doi: 10.2218/resmedica.v6i2.841
Irving, J.B. Stereognosis, Res Medica 1968, 6(2), pp. 23, 25-27
doi:10.2218/resmedica.v6i2.841
STEREOGNOSIS
JO H N
B. IRVIN G, B.Sc.
Functional A natom y
n eu ro an ato m y.
It has sp ecific co n n e ctio n s
w ith th e ven tro-b asal co m p le x o f th e th alam u s,
the term in atio n o f the ascen d in g so m atic
sen sory tracts.
P o ste rio rly an d in fe rio rly the lo b e m erges
w ith the o cc ip ital an d tem p o ral lob es and the
areas co n cern ed p rim arily w ith visu al and
au d ito ry stim u li respectively.
B etw e e n th e p rim ary sensory areas, th ere are
the so-called asso ciatio n areas, o f w h ich the
p o sterio r p arietal lo b e is a part. I t is often
stated that this area is th e cen tre fo r in teg
ration o f visual an d so m atic sen sation s and
fo r d isc rim in ative fu n ctio n s such as stereognosis. T h e r e is in d eed e vid en ce th at so m atic
and visu al stim u li m ay evok e e le ctrical activ ity
there. T h is activ ity h o w e ve r is n on -specific,
b ein g o f lo n g la te n cy and slo w a d ap tatio n an d
sim ilar results w ou ld b e o b ta in e d b y record in g
in an y part o f the cortex. S u ch a co n ce p t (i.e.
separation o f p rim ary from d isc rim in ative or
in tegrated sen sation ) can n o t b e tested fro m
clin ical studies sin ce the p ath o lo g ical processes
in volved are n o t su ffic ie n tly precise.
T h e d elin e atio n o f th ese areas in the
co rtex h as been a co n se q u en ce o f th e lack o f
accu racy in th e tech n iq u es used. W it h the
in tro d u ctio n o f sin gle n eu ro n e record in g, it
b ecom es n ecessary to lo o k a t th e co rtex, n o t as
groups o f in d e p e n d e n t n eu ron es in b o xes b u t
as grad ien ts o f a ctivity.
M a x im u m so m atic
sen sory sensation is fo u n d in the p o st cen tral
gyrus.
H a v in g noted the a n ato m ical b ed in w h ich
C lin ic a l
A stereo gn o sis is on e o f the agn o sias, byd e fin itio n a failu re o f re co gn itio n .
C lin ic a l
e xam in atio n , u sin g such co m m o n o b je cts as
keys, coins, pen tops, is n o t d esign ed to d iffe r
e n tiate the types o f agno sia.
A co n ve n ie n t
classification is in to re cep tive (in pu t) and
exe cu tive (ou tp u t). A n e x a m p le w ill sh ow the
d ifferen ce.
S p e rry e t a l (19 6 2 ) stu d ied p atie n ts w h o had
u n d ergo n e section o f th e corpus callo su m for
in tractab le seizures.
In righ t-h an ded p e o p le
p o sto p e rativ e ly, astereognosis o f the le ft hand
w as m ark ed , if the responses w ere given verb
ally.
H o w ev e r, co rrect answ ers w ere given
w h en th e p a tie n t selected th e o b je ct from a
list presen ted to the le ft eye. In o th e r w ords,
o n e side o f the brain did n o t k n o w w h a t the
o th e r was doin g. T h e agnosia w as th erefore
d u e to a d e fe ct in th e exe cu tive or o u tp u t
m e ch an ism b y v irtu e o f th e loss o f co n n ectio n s
b etw een the so m atic sensory area and the
speech centre.
G e sc h w in d
(19 6 2 ), in review in g several
p atien ts w ith proven vascu lar lesions o f the
corpu s callo su m , d escribed sim ilar results. H e
w e n t fu rth e r to suggest th at lesion s o f the
p o sterio r p arietal region w ere e q u ivale n t to
section o f the corpus callo su m sin ce the on ly
co n n e ctio n s b etw een the p arietal lob es o f each
h e m isp h e re arise in th at area. A stereogn osis,
th o u g h t to b e d u e to th e d isru p tio n o f the
cen tre fo r stereognosis in the p o sterio r parietal
lo b e o f th e n o n -d o m in an t h e m isp h e re , is morelik e ly to b e d u e to in terru p tio n o f the co n
n ectio n s to th e sp eech area.
C le a rly clin ical tests sh ou ld take a cco u n t of
these findings.
F o r exam p le , S e m m es e t al (19 5 9 ) studied a
g ro u p o f w ar veterans su fferin g from p e n e trat
in g b rain in ju ries o f the p arietal lo b e. T h e
p atien ts, d ivid ed in to grou p s acco rd in g to the
locu s o f the in ju ry, as d eterm in ed b y X -ray,
w ere given variou s tests o f so m atic sensory
fu n ctio n .
R e su lts suggested that there w ere
d iffe re n t p attern s o f lo calisatio n o f fu n c tio n in
each h em isp h ere. N o atten tio n w as paid h o w ever to non-verbal testing so th at the d iffe re n t
p attern s cou ld be a co n se q u en ce o f an exec
u tive agnosia, d u e to separatio n o f the somaticsensory area fro m the speech area in the co n
tralateral h em isp h ere.
25
N europhysiology
N e u r o p h y s i o l o g i c a l - C l i n i c a l C o r r e la t i o n s
26
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H olm es G. (1927). Brain, 50, 413.
M ountcastle V. B. et al. (1957). J. N europhysiol..
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M ountcastle V.B. e t al. (1959). Bull. Johns H opkins
H osp., 105, 200.
M ountcastle V. B. et al. (1960). Bull. Johns H opkins
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