Res Medica, Summer 1968, Volume VI, Number 2

Page 1 of 5

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.

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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.

A dissertation read before the Royal Medical Society

on Friday, Fe b ru ary 2nd, 1968.

S t ereognosis m ay b e d efin ed as the ab ility

to recogn ise o b je cts u sin g o n ly tactile (som atic)
sen sation .
T h e a b ility is b est d evelop ed in
b lin d p e o p le an d d ep en d s on m e m o ry and on
an in ta ct so m atic sen sory system .
L o ss o f this ab ility , astcreogn osis, is usu ally
con sid ered as a d e fe c t in so m atic sen sation . A
n ative o f N e w G u in e a , alth o u g h he m ig h t be
u n ab le to recogn ise th e o b je cts c o m m o n ly used
to test fo r stereogn o sis, w o u ld n o t d eserve to
b e given th e diagnosis o f a co rtical lesion .
M is failu re is a failu re o f learn in g. P atien ts
su fferin g from d em en tia m ay sh o w astereognosis as a co n seq u en ce o f a gen eral d eterio r
ation in m en tal fu n c tio n .
L e a rn in g and
m e m o ry th erefore p la y an im p o rta n t p art in
stereogn o sis, b u t in clin ical p ractice an d in
p h ysio lo g y, m ore in terest is taken in the
fu n ctio n o f th e so m atic sensory system .

Functional A natom y

C la ssica lly , astcreogn osis is associated w ith

lesion s o f th e p arietal lo b e . T h is area is not
a fu n ctio n a l e n tity , b e in g m e re ly th at p art of
th e cereb ral cortex b en eath th e p arietal b ones.
A d egree o f fu n ctio n a l lo calisatio n has been
in tro d u ced by e xp erim en ts in n e u ro an ato m y
an d n e u ro p h ysio lo gy.
A n te rio rly , th e p ost
cen tral gyrus is d istin ct on th e e vid en ce from
stu d ies o f evoked p o te n tials in an im als, from
stim u latio n exp e rim en ts in co n scio u s patien ts
at operation and from degen eratio n studies in

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

stereogn o sis w orks, the clin ical aspects w ill be

e xam in ed .

S m a lle r lesion s, again w ar in ju ries, w ere

d escribed b y R u ssell in 19 4 5 .
T h e patien ts
studied suffered su perficial skull w o u n d s in
v o lvin g o n ly sm all areas o f th e co rtex. T h e
effects w ere u su ally tran sien t.
Several eases,
in w h ich lesion s o f th e p ost cen tral gyru s w ere
d em o n strate d , sh ow ed a localised loss o f
stereognosis and tw o p o in t d iscrim in atio n in
the co n tralateral u p p e r lim b . T a c t ile sense,
lig h t touch p in p rick , w as in tact th ou gh so m e w h at ch an g ed in ch aracter, b e in g d ifficu lt to
localise.
W h ile this im p ro ve d , astereognosis
w as n early alw ays p erm an en t.
Stereogn osis is c learly d e p e n d e n t on an
in tact p o st cen tral gyrus.
In clin ical p ractice, astereognosis is on ly
im p o rtan t as part o f th e p arietal lo b e syn d ro m e,
w h ich m ay b e illu strated b y a d escrip tio n o f
tw o cases w ith lesion s o f th e righ t (n o n d o m in an t) h em isp h ere. D e n n y B ro w n et a l
(19 5 2 ) reported in d etail th e case o f a w om an
o f fifty-tw o w ith a vascu lar lesion o f th e righ t
parietal lob e. T h e m o st ch aracteristic featu re
was co m p le te n eglect o f th e le ft sid e, e sp ecially
w hen stim u lated sim u ltan e o u sly on the right.
T h e le ft arm was n o t recognised as p art of
her b od y, m o to r co o rd in atio n was d e fe c tiv e as
show n b y h er dressin g ap raxia. A stereogn osis
an d loss o f tw o p o in t d iscrim in atio n was
m arked on th e le ft, as also w as p o o r lo calis
atio n o f site o f tactile stim u latio n .
T h e secon d case, a p atie n t o f D r. J e llin ek,
N o rth e rn G e n e ra l H o sp ita l, is a fifty-six-yearold lorry driver. H e w as a d m itte d to h o sp ital
fo llo w in g tw o accid en ts w ith in on e m o n th ,
b o th in v o lv in g cars parked on the le ft sid e o f
the road. In v e stig atio n s sh o w ed th at he had
a large b ro n ch ial carcin om a w ith a sin gle
m etastasis in th e righ t p arietal region.
On
clin ical e xam in atio n , h e show ed n eglect o f the
le ft side.
A stereo gn o sis, loss o f tw o p o in t
d iscrim in atio n
an d
p oor localisation
w ere
n oted .
T h e r e was m ild slu rrin g o f sp eech ,
m arked m o to r in co o rd in atio n as show n b y his
in a b ility to w alk an d dressin g ap raxia.
In
h o sp ital his co n d itio n d eteriorated an d he
w as discharged to term in al care.
W h e n re
ad m itte d tw o m o n th s later, his co n d itio n was
im p ro ved , clin ical signs w ere m u ch less m arked
and in vestigation w ith rad io active scan n in g
show ed that th e parietal lesion had been re
du ced in size.
W h a t co n clu sio n s can b e draw n from these
cases?
A stereogn osis is o n ly im p o rtan t in
clin ical w ork as p art o f th e p arietal lo b e syn
drom e.
P resen t e vid en ce docs n o t allow

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

presentation o f the body surface in the post

central gyrus; all cells recorded in one vertical
tract o f the m icroelectrode have receptive
fields in one area o f the body, the size of the
field depending on the concentration o f re
ceptors in that part of the body; neuroanatom ical studies show that the cortex is
organised in a vertical direction; and studies
in monkeys showed that no learning nor be
havioural changes were detected after m ultiple
sectioning of the som atic sensory cortex in
small vertical planes, i.e. intercortical connec
tions were not im portant, at least in tactile
conditioned behaviour. M icroelectrode studies
in the visual cortex have shown a sim ilar
pattern o f organisation.
T h e second group of cells tended to be
recorded from random depths in the cortex,
in contrast to G ro u p 1 which tended to be
found m ost often in the I V t h layer. T h e
responses to stim ulation were characteristically
sensitive to depth of anaesthesia, slowly adapt
ing and of long latency. T h e receptive fields
were large, at times ipsilateral and labile.
Such properties arc characteristic o f a m ultisynaptic pathway.

accurate localisation although the post central

gyrus m ust b e intact.
T h e second conclusion is that stereognosis
and two point discrim ination seem to be
linked. D en n y B row n, noting this, suggested
that the function o f the parietal lobe som atic
sensory areas is to integrate spatial inform ation
a process lie called m orphosynthesis . It
is not surprising that the two functions are
linked since stereognosis is only a quantitative
extension of two point discrim ination plus in
form ation from joint receptors.
T h e add
itional essential feature of m orphosynthesis is
coordination o f m ovem ent. T h is is recognised
from personal experience one norm ally
identifies objects by rolling them in the hand,
and from experience o f hem iplegic patients
who show astereognosis on the a ffected side.

N europhysiology

T h e concept o f m orphosynthesis is attractive

when considered in relation to neurophysiological findings, on which further study of the
processes of integration m ust depend.
M ountcastle et al (19 5 7, 19 59, 1 960), using
m icroelectrodes, studied single neurones in
the som atic sensory areas of the cortex in cats
and m onkeys. T w o distinct populations of
cells were found. G ro u p 1 were m ore num er
ous.
T h e characteristic property was the
response, o f short latency and rapid adaptation,
to a stim ulus in a specific small receptive field.
T h e stim ulus was cither hair bending, light
touch or gentle joint rotation and the response
could be inhibited by stim ulating areas round
about the receptive field. C ells in the ventrobasal com plex and in the gracile and cuneate
nuclei of the dorsal colum ns o f the spinal
cord had sim ilar properties, suggesting that
inform ation is transm itted in independent
channels to the cortex. Integration relies on
surrounding inhibition to make the stim ulus
discrete. Secondly, m ovem ent is im portant be
cause of the property of rapid adaptation. In
other words, when the object remains in one
part of the hand, the initial activity, signalling
that the object is present, w ould rapidly fade
and no recognition would be possible. M o ve
m ent reinforces the neuronal activity.
T h e presence of an object appears to be
appreciated in the form of neuronal activity in
anatom ically fixed parts o f the somatosensory
cortex. T h e evidence for this fixed pattern is
that: there is an accurate point-to-point re

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

C learly this activity would be too im precise

for the type o f sensation required for stereognosis. T h e two groups o f cells appear to be
m utually antagonistic since activity in G roup
I inhibits that in G ro u p II. T h is m ay be
im portant clinically since the two systems
resem ble the characteristics of the two types
of sensation proposed by Mead and H olm es
(1927) i.e., epicritic (G rou p I) and protopathic
(G roup II).
Follow in g cortical lesions, the
character of tactile sensation appears to becom e m ore protopathic. Is it possible that
cortical lesions selectively destroy G ro u p I
cells? T h is m ight be true for ischaem ic lesions
which result in pronounced necrosis o f the
IV th layer of cells, but it would be difficult
to explain the gunshot injuries on the same
basis. Such a hypothesis would be w orthy of
investigation, considering the nature of the
residual sensation i.e., poor localisation and
defective stereognosis.
G ro u p I cells seem well designed to carry
out the process of m orphosynthesis, the
initial step in stereognosis, taking place in the
post central gyrus. T h e cells respond to light
touch, hair bending and joint rotation, partie-

26

ularly if the stim ulus moves so that no one

group of cells are active for a long period.
Join t sensation seems to be particularly im portant for posture, for know ing where the
body is in space and for recognition of three
dim ensional objects. T h is could be dem on
strated in the experim ents of Provins in which
h e injected local anaesthetic into the joint
capsules of the interphalangeal joints (1958).
Conclusion

In summ ary, therefore, the physiological pro

cesses underlying stereognosis have been exam

ined, with particular reference to clinical

observations of patients with parietal lobe
lesions. L ittle attention has been paid to the
psychological aspects of such lesions, to the
influence o f learning and to the extent of
adaptation to a disability.
T h e evidence suggests that stereognosis re
quires an intact post central gyrus in much
the same way as peripheral sensation requires
intact spinal nerves. T h e role o f the posterior
parietal region is less well defined. In clinical
practice however, astereognosis is only im port
ant as part of the parietal lobe syndrome.

REFERENCES
Denny-Brow n D. e t al. (1952). Brain, 75, 433.
G eschw ind N. & Kaplan M. (1962). N eurology, 12,
675.
H olm es G. (1927). Brain, 50, 413.
M ountcastle V. B. et al. (1957). J. N europhysiol..
20, 408.
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
H osp., 106, 275.

M ountcastle V. B. e t al. H a n dbook of Physiology

(neurophysiol, vol. II).
Provins J. (1958). J. Physiol., 143, 58.
Russell E. R. (1945). Brain, 68, 79.
Sem m es et al. (1959). Som atosensory Changes
a fter P en etratin g B rain W ounds in M an", New
York.
Sperry R. et al. (1962). New Eng. J. M ed., 266, 1013.

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