Visual anomia: a unidirectional disconnection

A right-handed patient with a complete right homonymous hemianopia could not name objects seen in her left hemifield but could always select an object from an assortment when the object was named. If the right hemisphere was devoid of auditory language function, we must postulate separate transcallosal pathways from visual to verbal and from auditory language to visual information. Because only the former pathway was interrupted, our patient exhibited a "unidirectional" disconnection.     

Language lateralisation and early right ear deafness: was Wernicke right?

The effects of early right ear deafness on lateralisation of auditory language functions are not fully known. A 36 year old right handed man, with a history of perinatal right ear deafness and undergoing evaluation for surgical treatment of seizures that began at age 10 years was studied. Language lateralisation testing by intracarotid sodium amobarbital injection showed receptive and expressive language functions to be strongly lateralised to the left hemisphere. Results with intracarotid sodium amobarbital injection further suggested that transmission of auditory input to the patient's left hemisphere was partially dependent on ipsilateral left ear pathways. Cortical language mapping through implanted subdural electrodes localised auditory language functions to traditional left posterior perisylvian language areas. These results suggest that early right ear deafness does not impede left hemisphere lateralisation and localisation of auditory language functions. Moreover, transmission of auditory information to the patient's left hemisphere seems to be accomplished, in part, by recruitment of ipsilateral left ear pathways.     

Auditory verbal hallucinations in schizophrenia as aberrant lateralized speech perception: evidence from dichotic listening

We report evidence that auditory verbal hallucinations (AVH) in schizophrenia patients are perceptual distortions lateralized to the left hemisphere. We used a dichotic listening task with repeated presentations of consonant-vowel syllables, a different syllable in the right and left ear. This task produces more correct reports for the right ear syllable in healthy individuals, indicative of left hemisphere speech processing focus. If AVHs are lateralized to the left hemisphere language receptive areas, then this should interfere with correct right ear reports in the dichotic task, which would result in significant negative correlations with severity of AVHs. We correlated the right and left ear correct reports with the PANSS hallucination symptom, and a randomly selected negative symptom, in addition to the sum total of the positive and negative symptoms, in 160 patients with schizophrenia. The results confirmed the predictions with significant negative correlations for the right ear scores with the PANSS hallucination item, and for the sum total of positive symptoms, while all other correlations were close to zero. The results are unambiguous evidence for AVHs as aberrant speech perceptions originating in the left hemisphere.     

Ipsilateral auditory extinction following frontal and basal ganglia lesions of the left hemisphere

When tested on a dichotic digits listening task, patients with unilateral lesions of the left frontal lobe and left anterior basal ganglia exhibited ipsilateral auditory extinction. This phenomenon has been documented before, but only in patients with lesions involving the region posterior and lateral to the posterior aspect of the left lateral ventricle. As patients with lesions in the equivalent region of the right hemisphere also exhibit extinction of verbal material arriving in their left ears it has been hypothesized that these posterior lesions disrupt an interhemispheric pathway connecting the two temporal lobes. As it appears that the ipsilateral auditory pathways are suppressed under conditions of dichotic stimulation, such an interhemispheric pathway would be the means whereby left-ear verbal stimuli reached the left (speech) hemisphere. Therefore a disruption of this pathway could result in left-ear extinction for verbal material. The finding that left anterior lesions also result in left-ear extinction poses problems for this hypothesis and in particular for the suggested posterior route of the interhimispheric pathway.     

Assessment of hemispheric dominance for language in crossed aphasia by two atraumatic methods

In a right handed patient with crossed aphasia, two atraumatic techniques (regional cerebral blood flow measurements during the performance of a linguistic task and dichotic listening test) were used to assess language lateralization. The prominence of rCBF activation patterns in the right hemisphere and the presence of a clear-cut right ear extinction on the dichotic listening test provide evidence that, is this case, the right hemisphere was dominant for language.     

Landau-Kleffner syndrome: epileptic activity in the auditory cortex.

The Landau-Kleffner syndrome (LKS) is characterized by electroencephalographic spike discharges and verbal auditory agnosia in previously healthy children. We recorded magnetoencephalographic (MEG) spikes in a patient with LKS, and compared their sources with anatomical information from magnetic resonance imaging. All spikes originated close to the left auditory cortex. The evoked responses were contaminated by spikes in the left auditory area and suppressed in the right--the latter responses recovered when the spikes disappeared. We suggest that unilateral discharges at or near the auditory cortex disrupt auditory discrimination in the affected hemisphere, and lead to suppression of auditory information from the opposite hemisphere, thereby accounting for the two main criteria of LKS.     

Language disorders in Landau-Kleffner syndrome

In the present long-term study, we analyzed language disorders in four patients with Landau-Kleffner syndrome. Their common first symptoms were disability in understanding spoken words, followed by inarticulation and a decreased amount of speech. All patients showed auditory verbal agnosia to some degree at some stage of their illness. However, one patient showed typical sensory aphasia as the first symptom, and another patient showed nonverbal auditory agnosia followed by pure word deafness. Thus, patients with Landau-Kleffner syndrome show sequential and sometimes hierarchical language disorders beginning with sensory aphasia, followed by auditory agnosia, and finally word deafness during their disease process. During long-term follow-up (20 to 30 years), all patients showed marked recovery in language without any intellectual handicap, but with some disability in spoken language, auditory verbal perception, and a discrepancy between Wechsler Verbal and Performance IQ scores.     

Nonverbal auditory agnosia with lesion to Wernicke's area

We report the case of patient M, who suffered unilateral left posterior temporal and parietal damage, brain regions typically associated with language processing. Language function largely recovered since the infarct, with no measurable speech comprehension impairments. However, the patient exhibited a severe impairment in nonverbal auditory comprehension. We carried out extensive audiological and behavioral testing in order to characterize M's unusual neuropsychological profile. We also examined the patient's and controls’ neural responses to verbal and nonverbal auditory stimuli using functional magnetic resonance imaging (fMRI). We verified that the patient exhibited persistent and severe auditory agnosia for nonverbal sounds in the absence of verbal comprehension deficits or peripheral hearing problems. Acoustical analyses suggested that his residual processing of a minority of environmental sounds might rely on his speech processing abilities. In the patient's brain, contralateral (right) temporal cortex as well as perilesional (left) anterior temporal cortex were strongly responsive to verbal, but not to nonverbal sounds, a pattern that stands in marked contrast to the controls’ data. This substantial reorganization of auditory processing likely supported the recovery of M's speech processing.     

Thalamic neglect

Thalamic lesions can provoke negligence behavior with various, sometimes dissociated manifestations: motor negligence or reduction in use of one half of the body whatever the direction of the gesture or the half-space in which it occurs; extinction phenomena demonstrated without difficulty for visual, somatesthetic and auditory modalities; spatial negligence involving attentional and intentional components, often difficult to distinguish. Negligence of this type is mainly the result of right sided lesions, with several non-exclusive explanations: natural predominance of the left hemisphere, activating role of language with respect to the left hemisphere, capacity of the right hemisphere to be "attentive" to bath half-spaces in contrast to the left hemisphere, attentive to the right half-space only.     

Right hand agraphia and left hand apraxia following callosal damage in a right-hander

A right-handed Japanese man showed agraphia more marked with the right hand, apraxia confined to the left hand, and right ear extinction on dichotic listening, following damage to the anterior two-thirds of the corpus callosum, the rostral and lower parts of the right medial frontal lobe and a small portion of the left medial frontal lobe. The symptoms were attributed to hemispheric disconnection, on the assumption that the right hemisphere was dominant for language and the left for limb praxis. This case provides good evidence for dissociated lateralization of language and limb praxis in some right-handed individuals. The study of writing performance suggested the following hypotheses: (1) motor engrams for limb praxis and writing may be dissociated, and (2) motor engrams for writing Kana (phonogram) and Kanji (ideogram) letters are represented on both hemispheres, although the hemisphere nondominant for language seems unable to combine graphemes into a correct meaningful sequence.     

Left hemisphere damage and selective impairment of auditory verbal short-term memory. A case study

The case of a left-hemisphere damaged patient with an impairment of auditory verbal memory span is described. The neuropsychological study showed a dissociation between short-term and long-term auditory verbal memory, which may be attributed to a selective defect of auditory verbal short-term memory. Since a tachistoscopic study displayed a short-term memory superiority of the left hemisphere, it can be argued that the performance for visual verbal stimuli may still be held by the left hemisphere, albeit computerized tomography showed a left-hemisphere lesion involving the whole language area.     

Infarct of the anterior limb of the right internal capsule causing left motor neglect: case report and cerebral blood flow study

A sixty-nine year old hypertensive man had left motor neglect following an infarct of the anterior limb of the right internal capsule. He also had left auditory extinction on verbal dichotic listening and a sligh constructional apraxia. Regional cerebral blood flow (CBF) was measured at rest with Xenon 133 inhalation and was found to be slightly decreased in a diffuse fashion. Motor activation of the right hand resulted in an increase of CBF in the contralateral superior rolandic area, whereas no such increase was found during motor activation of the left hand. This lack of cortical CBF increase on contralateral motor activation is interpreted as a consequence of the failure of some corticosubcortical connexions involved in motor arousal. The specifically dynamic appearance of regional CBF abnormalities, i.e. during selective activation as opposed to rest measurements, is consistent with the functional character of neglect.     

Auditory neglect.

Auditory neglect was investigated in normal controls and in patients with a recent unilateral hemispheric lesion, by requiring them to detect the interruptions that occurred in one ear in a sound delivered through earphones either mono-aurally or binaurally. Control patients accurately detected interruptions. One left brain damaged (LBD) patient missed only once in the ipsilateral ear while seven of the 30 right brain damaged (RBD) patients missed more than one signal in the monoaural test and nine patients did the same in the binaural test. Omissions were always more marked in the left ear and in the binaural test with a significant ear by test interaction. The lesion of these patients was in the parietal lobe (five patients) and the thalamus (four patients). The relation of auditory neglect to auditory extinction was investigated and found to be equivocal, in that there were seven RBD patients who showed extinction, but not neglect and, more importantly, two patients who exhibited the opposite pattern, thus challenging the view that extinction is a minor form of neglect. Also visual and auditory neglect were not consistently correlated, the former being present in nine RBD patients without auditory neglect and the latter in two RBD patients without visual neglect. The finding that in some RBD patients with auditory neglect omissions also occurred, though with less frequency, in the right ear, points to a right hemisphere participation in the deployment of attention not only to the contralateral, but also to the ipsilateral space.     

Unilateral auditory language comprehension on the token test following cerebral commissurotomy and hemispherectomy

Two versions of the Token Test for auditory language comprehension were administered unilaterally to selected commissurotomy and post-infantile hemispherectomy patients. No deficit was found for the left hemisphere while the right showed a severe deficit comparable to that of left brain-damaged asphasics. Error analysis, however, revealed that the right hemisphere was more sensitive to perceptual and (short term auditory verbal) memory constraints in the task, whereas aphasics were more sensitive to linguistic variables. Mean overall scores of the right hemispheres on the Token Test were comparable to 4 yr old children as contrasted with a high mental age estimate—mean 11 yr— on the Peabody Picture Vocabulary Test. It is suggested that in the normally developing brain, distinct language functions exhibit disparate ontogeneses of lateralization in the left hemisphere.     

A study of functional plasticity of the brain in childhood. I. Critical period dislodging lateralization of language in the brain]

To investigate the functional plasticity of the brain in childhood, the intelligence and language tests, brain CT and dichotic listening test were performed on 34 patients with hemiplegia. All 13 patients with left hemiplegia, 8 to 37 years old, showed a right ear dominance suggesting the lateralization of language in the left hemisphere. Among 21 patients with right hemiplegia, 7 to 22 years old, 16 patients who had suffered from the left hemispheric damage before 6 years and 1 month of age, showed the left ear dominance suggesting the lateralization of language in right hemisphere except 2 patients. On the contrary, 3 patients with right hemiplegia who had suffered from the left hemispheric damage after 6 years and 6 months of age showed a right ear dominance. It was concluded that the critical period for the dislodging of language lateralization in the brain from the damaged left hemisphere to the intact right hemisphere is the first half of 6 years after birth. Five patients out of 8 patients with right hemiplegia showed significantly lower scores in performance than in verbal WISC IQ. The compensation of language function rather than performance function was considered to be characteristic for the left-hemispheric damage in childhood.     

Visual and tactile agnosia

A patient presented with visual and tactile agnosia due to a spontaneous left occipito-temporal hematoma. Major memory and spatial orientation disorders were also noted, but language, gestures, auditory and olfactory perception, and interior visual imagerie were unaffected. A review of the literature since 1970 found 6 cases of an association of this type among 17 patients with visual agnosia. There appears to be no relationship between the presence of tactile agnosia and the global or partial character of the visual agnosia, the severity of memory disturbances, the presence of visuoverbal disconnection or visual imagery disorders. In contrast, these cases differed in that the lesions were more extensive and extended beyond the internal occipital regions: they were widespread in 3 cases and in the left internal occipital and parietal region in 1 case. In the patient reported in this paper there was a wide lesion of the posterior white matter of the left hemisphere.     

Cerebral and callosal organisation in a right hemisphere dominant "split brain" patient.

Patients described in previous reports who have undergone corpus callostomy for control of seizures have been left hemisphere dominant for language. To determine the hemispheric localisation (and possible coexistence) of language and traditional right hemisphere skills in reversed dominance, the first right hemisphere dominant corpus callostomy patient was studied. Localisation of callosal functions was also investigated, as MRI showed 1.5 cm of spared callosal body. The patient, KO, a 15 year old girl with familial left handedness, underwent two stage callosotomy in 1988. Lateralised visually presented stimuli requiring same or different comparisons between visual fields showed chance performance. Oral naming and reading showed better performance by the right hemisphere than the left, whereas both hemispheres were proficient in auditory comprehension. Active voice syntax was above chance only in the right hemisphere. Face recognition was significantly better in the right hemisphere than in the left. Tasks requiring tactile comparisons between hands showed above chance performance except in the instance in which the non-dominant right hand was stimulated first in a point localisation task between hands. This case showed hemispheric coexistence of language and traditional right hemispheric skills in a corpus callosotomy patient with reversed language dominance. Tactile transfer was localised to the mid-posterior callosal body.     

Identification and discrimination disorders in auditory perception: a report on two cases

Auditory perception was investigated in two brain-damaged subjects. The first patient had a left temporoparietal ischaemic lesion. He presented a right-ear extinction in dichotic tasks, as well as difficulties in understanding and repeating verbal material and impaired identification of melodies. All discrimination tests were well performed. The second patient had a right capsulolenticular and frontal ischaemic lesion. He presented a left ear dichotic extinction and severe difficulties in discrimination of environmental sounds and melodies but no major difficulty in naming and identification. From these results, it is hypothesized that identification and discrimination involve distinct mechanisms within the processing of auditory stimuli, and that they may be selectively disrupted in brain-damaged subjects.     

Side of the stimulated ear influences the hemispheric balance in coding tonal stimuli

OBJECTIVE: To evaluate whether the side of stimulated ear affects the hemispheric asymmetry of auditory evoked cortical activations. METHODS: Using a whole-head neuromagnetometer, we recorded neuromagnetic approximately 100 ms responses (N100m) in 21 healthy right-handers to 100 ms 1 kHz tones delivered alternatively to left and right ear. RESULTS: Although the peak latencies of N100m were shorter in contralateral than in ipsilateral hemisphere, the difference was significant only for the left ear stimulation. Based on the relative N100m amplitudes across hemispheres, the laterality evaluation showed a rightward predominance of N100m activation to tone stimuli, but the lateralization toward the right hemisphere was more apparent by the left than by the right ear stimulation (laterality index: -0.27 versus -0.10, p=0.008). Within the right hemisphere, the N100m was 2-4 mm more posterior for left ear than for right ear stimulation. CONCLUSIONS: The hemispheric asymmetry in auditory processing depends on the side of the stimulated ear. The more anterior localization of right N100m responses to ipsilateral than to contralateral ear stimulation suggests that there might be differential neuronal populations in the right hemisphere for processing spatially different auditory inputs.     

Generalized auditory agnosia with spared music recognition in a left-hander. Analysis of a case with a right temporal stroke

After a right temporoparietal stroke, a left-handed man lost the ability to understand speech and environmental sounds but developed greater appreciation for music. The patient had preserved reading and writing but poor verbal comprehension. Slower speech, single syllable words, and minimal written cues greatly facilitated his verbal comprehension. On identifying environmental sounds, he made predominant acoustic errors. Although he failed to name melodies, he could match, describe, and sing them. The patient had normal hearing except for presbyacusis, right-ear dominance for phonemes, and normal discrimination of basic psychoacoustic features and rhythm. Further testing disclosed difficulty distinguishing tone sequences and discriminating two clicks and short-versus-long tones, particularly in the left ear. Together, these findings suggest impairment in a direct route for temporal analysis and auditory word forms in his right hemisphere to Wernicke's area in his left hemisphere. The findings further suggest a separate and possibly rhythm-based mechanism for music recognition.