Pure associative tactile agnosia for the left hand: clinical and anatomo-functional correlations.

ABSTRACT

Associative tactile agnosia (TA) is defined as the inability to associate information about object sensory properties derived through tactile modality with previously acquired knowledge about object identity. The impairment is often described after a lesion involving the parietal cortex (Caselli, 1997; Platz, 1996). We report the case of SA, a right-handed 61-year-old man affected by first ever right hemispheric hemorrhagic stroke. The neurological examination was normal, excluding major somaesthetic and motor impairment; a brain magnetic resonance imaging (MRI) confirmed the presence of a right subacute hemorrhagic lesion limited to the post-central and supra-marginal gyri. A comprehensive neuropsychological evaluation detected a selective inability to name objects when handled with the left hand in the absence of other cognitive deficits. A series of experiments were conducted in order to assess each stage of tactile recognition processing using the same stimulus sets materials, 3D geometrical shapes, real objects and letters. SA and seven matched controls underwent the same experimental tasks during four sessions in consecutive days. Tactile discrimination, recognition, pantomime, drawing after haptic exploration out of vision and tactile-visual matching abilities were assessed. In addition, we looked for the presence of a supra-modal impairment of spatial perception and of specific difficulties in programming exploratory movements during recognition. Tactile discrimination was intact for all the stimuli tested. In contrast, SA was able neither to recognize nor to pantomime real objects manipulated with the left hand out of vision, while he identified them with the right hand without hesitations. Tactile-visual matching was intact. Furthermore, SA was able to grossly reproduce the global shape in drawings but failed to extract details of objects after left-hand manipulation, and he could not identify objects after looking at his own drawings. This case confirms the existence of selective associative TA as a left hand-specific deficit in recognizing objects. This deficit is not related to spatial perception or to the programming of exploratory movements. The cross-modal transfer of information via visual perception permits the activation of a partially degraded image, which alone does not allow the proper recognition of the initial tactile stimulus.