Tactile morphagnosia secondary to spatial deficits

Distinguishing transient from persistent tactile agnosia after partial anterior circulation infarcts - Behavioral and neuroimaging evidence for white matter disconnection

From a cohort of 36 patients presenting apperceptive tactile agnosia after first cortical ischemic stroke, 14 showed temporary impairment at admission. A previous multi-voxel analysis of the cortical lesions, using as explanatory variable the course of tactile object recognition performance over the recovery period of 9 months, partitioned the cohort into three subgroups. Of the 14 patients constituting two of the subgroups, 7 recovered from their impairment whereas 7 did not. These two subgroups could not be distinguished at admission. The primary aim of the present study is to present two assessments that can do so. The first assessment comprises a pattern of behavioral measures, determined via principal component analysis, encoded in three tests: picking small objects, macrogeometrical discrimination and tactile object recognition. The receiver operating characteristic curve derived from permutation of the behavioral test scores yielded an 80% probability of correct identification of the patient subgroup and an 8% probability for false identification. As done with the permuted scores, the pattern could predict the persistence of affliction of new stroke patients with tactile agnosia. The second predictive assessment extends our previous evaluation of cortical MRI lesion maps to include subcortical regions. Confirming our previous study, the lesions of the persistently impaired subgroup disrupted significantly the anterior arcuatus fasciculus and associated superior longitudinal fasciculus III in the ipsilesional hemisphere, impeding reciprocal information transfer between supramarginal gyrus and both the ventral premotor cortex and Brodmann area 44. Due to the importance of interhemispheric information transfer in tactile agnosia, we performed a supplementary analysis of tactile object recognition scores. It showed that haptic information transfer from the non-affected to the affected hands in the persistent cases partly restored function during the nine months, possibly following restoration of functional interhemispheric haptic information transfer at the border of posterior corpus callosum and splenium. In conclusion, the combined findings of the cortical lesion at subarea PFt of the inferior parietal lobule and the associated subcortical tract lesions permit almost perfect prediction of persistent impairment of tactile object recognition. The study substantiates the need for combined analysis of both cortical lesions and white matter tract disconnections.

Case study: A selective tactile naming deficit for letters and numbers due to interhemispheric disconnection

The role of white matter pathways in cognition is a topic of active investigation that is vital to both the fields of clinical neurology and cognitive neuroscience. White matter pathways provide critical connectivity amongst numerous specialized brain regions thereby enabling higher level cognition. While the effects of dissections and lesions of the corpus callosum have been reported, it is less understood how unilateral focal white matter lesions may impact cognitive processes. Here, we report a unique case study in which a small left lateralized stroke in the white matter adjacent to the body of the corpus callosum selectively impaired the ability to name letters and numbers presented to the ipsilesional, left hand. Naming of letters, numbers and objects was tested in both the visual and tactile modalities in both hands. Diffusion-weighted imaging showed a marked reduction in white matter pathway integrity through the body of the corpus callosum. Clinically, this case highlights the significant impact that a focal white matter lesion can have on higher-level cognition, specifically the integration of verbal and tactile information. Moreover, this case adds to prior reports on tactile agnosia by including DTI imaging data and emphasizing the role that white matter pathways through the body of the corpus callosum play in integrating tactile input from the right hemisphere with verbal naming capabilities of the left hemisphere. Finally, the findings also provoke fresh insight into alternative strategies for rehabilitating cognitive functioning when structural connectivity may be compromised.

Recovery from tactile agnosia: a single case study

In a patient suffering from tactile agnosia a comparison was made (using the ABABAB paradigm) between three blocks of neuropsychological rehabilitation sessions involving off-line anodal transcranial direct current stimulation (anodal-tDCS) and three blocks of rehabilitation sessions without tDCS. During the blocks with anodal-tDCS, the stimulation was administered in counterbalanced order to two sites: i) the perilesional parietal area (specific stimulation) and ii) an occipital area far from the lesion (nonspecific stimulation).Rehabilitation associated with anodal-tDCS (in particular in the perilesional areas) is more efficacious than without stimulation.

Pure Amorphagnosia without Tactile Object Agnosia

A 54-year-old female showed amorphagnosia without ahylognosia and tactile agnosia 40 days after the onset of right cerebral infarction. Her basic somatosensory functions were normal. The appreciation of substance qualities (hylognosia) was preserved, but the patient's inability to recognize the size and shape (morphagnosia) was confined to 2- and 3-dimensional shapes (amorphagnosia) in the left hand. However, the patient's ability to recognize real daily objects was well preserved. Brain MRI after admission showed ischemic lesions confined to the right pre- and postcentral gyri and the medial frontal cortex on DWI and FLAIR images. An analysis of SPECT images revealed that the most decreased areas were localized to the pre- and postcentral gyri, superior and inferior parietal lobules, supramarginal gyrus, and angular gyrus. Considering the previous reported cases, the responsible lesion for the impaired perception of hylognosia and morphagnosia may not necessarily be confined to the right hemisphere. To date, 5 reports (6 cases) of tactile agnosia have been published; 4 cases presented with both ahylognosia and amorphagnosia, while 1 presented with only amorphagnosia, and another showed amorphagnosia and mild ahylognosia. Our case is the first to present with only amorphagnosia without tactile agnosia. The mechanism for the well-preserved recognition of real objects may depend on the preserved hylognosia. Of note, there have been no reports showing only ahylognosia without amorphagnosia. Further studies are necessary to clarify whether or not patients with preserved hylognosia or morphagnosia retain the ability to perceive real objects.

The role of self-touch in somatosensory and body representation disorders after stroke

Somatosensory impairments occur in about half of the cases of stroke. These impairments range from primary deficits in tactile detection and the perception of features, to higher order impairments in haptic object recognition and bodily experience. In this paper, we review the influence of active- and self-touch on somatosensory impairments after stroke. Studies have shown that self-touch improves tactile detection in patients with primary tactile deficits. A small number of studies concerned with the effect of self-touch on bodily experience in healthy individuals have demonstrated that self-touch influences the structural representation of one's own body. In order to better understand the effect of self-touch on body representations, we present an informal study of a stroke patient with somatoparaphrenia and misoplegia. The role of self-touch on body ownership was investigated by asking the patient to stroke the impaired left hand and foreign hands. The patient reported ownership and a change in affect over all presented hands through self-touch. The time it took to accomplish ownership varied, based on the resemblance of the foreign hand to the patient's own hand. Our findings suggest that self-touch can modulate impairments in body ownership and affect, perhaps by helping to reinstate the representation of the body.

Remember the touch: tactile distractors retrieve previous responses to targets

In selection tasks where target stimuli are accompanied by distractors, responses to target stimuli, target stimuli and the distractor stimuli can be encoded together as one episode in memory. Subsequent repetition of any aspect of such an episode can lead to the retrieval of the whole episode including the response. Thus, repeating a distractor can retrieve responses given to previous targets; this mechanism was labeled distractor-response binding and has been evidenced in vision and audition. Yet, previous research suggests possibly different distractor processing in the tactile as compared to the visual modality. In the present study, we therefore used a selection task in which participants always responded to one tactile stimulus while ignoring another. Evidence for the integration of tactile distractors with target responses was found in response times and errors. Our results indicate that binding of responses to distractors is a cognitive process that is independent of the stimulus' modality.

Tactile-visual integration in the posterior parietal cortex: a functional magnetic resonance imaging study

To explore the neural substrates of visual-tactile crossmodal integration during motion direction discrimination, we conducted functional magnetic resonance imaging with 15 subjects. We initially performed independent unimodal visual and tactile experiments involving motion direction matching tasks. Visual motion discrimination activated the occipital cortex bilaterally, extending to the posterior portion of the superior parietal lobule, and the dorsal and ventral premotor cortex. Tactile motion direction discrimination activated the bilateral parieto-premotor cortices. The left superior parietal lobule, intraparietal sulcus, bilateral premotor cortices and right cerebellum were activated during both visual and tactile motion discrimination. Tactile discrimination deactivated the visual cortex including the middle temporal/V5 area. To identify the crossmodal interference of the neural activities in both the unimodal and the multimodal areas, tactile and visual crossmodal experiments with event-related designs were also performed by the same subjects who performed crossmodal tactile-visual tasks or intramodal tactile-tactile and visual-visual matching tasks within the same session. The activities detected during intramodal tasks in the visual regions (including the middle temporal/V5 area) and the tactile regions were suppressed during crossmodal conditions compared with intramodal conditions. Within the polymodal areas, the left superior parietal lobule and the premotor areas were activated by crossmodal tasks. The left superior parietal lobule was more prominently activated under congruent event conditions than under incongruent conditions. These findings suggest that a reciprocal and competitive association between the unimodal and polymodal areas underlies the interaction between motion direction-related signals received simultaneously from different sensory modalities.

Somatosensory processes subserving perception and action

The functions of the somatosensory system are multiple. We use tactile input to localize and experience the various qualities of touch, and proprioceptive information to determine the position of different parts of the body with respect to each other, which provides fundamental information for action. Further, tactile exploration of the characteristics of external objects can result in conscious perceptual experience and stimulus or object recognition. Neuroanatomical studies suggest parallel processing as well as serial processing within the cerebral somatosensory system that reflect these separate functions, with one processing stream terminating in the posterior parietal cortex (PPC), and the other terminating in the insula. We suggest that, analogously to the organisation of the visual system, somatosensory processing for the guidance of action can be dissociated from the processing that leads to perception and memory. In addition, we find a second division between tactile information processing about external targets in service of object recognition and tactile information processing related to the body itself. We suggest the posterior parietal cortex subserves both perception and action, whereas the insula principally subserves perceptual recognition and learning.