On the structure of word deafness and mechanisms underlying the fluctuation of disturbances of higher cortical functions

Situating word deafness within aphasia recovery: A case report

Word deafness is a rare neurological disorder often observed following bilateral damage to superior temporal cortex and canonically defined as an auditory modality-specific deficit in word comprehension. The extent to which word deafness is dissociable from aphasia remains unclear given its heterogeneous presentation, and some have consequently posited that word deafness instead represents a stage in recovery from aphasia, where auditory and linguistic processing are affected to varying degrees and improve at differing rates. Here, we report a case of an individual (Mr. C) with bilateral temporal lobe lesions whose presentation evolved from a severe aphasia to an atypical form of word deafness, where auditory linguistic processing was impaired at the sentence level and beyond. We first reconstructed in detail Mr. C's stroke recovery through medical record review and supplemental interviewing. Then, using behavioral testing and multimodal neuroimaging, we documented a predominant auditory linguistic deficit in sentence and narrative comprehension-with markedly reduced behavioral performance and absent brain activation in the language network in the spoken modality exclusively. In contrast, Mr. C displayed near-unimpaired behavioral performance and robust brain activations in the language network for the linguistic processing of words, irrespective of modality. We argue that these findings not only support the view of word deafness as a stage in aphasia recovery but also further instantiate the important role of left superior temporal cortex in auditory linguistic processing.

Medulloblastoma presenting with pure word deafness: report of one case and review of literature

Pure word deafness (PWD) is a rare disorder characterized by impaired verbal comprehension sparing discrimination and recognition of nonverbal sounds with relatively normal spontaneous speech, writing, and reading comprehension. Etiologies of this syndrome are varied, and there are rare reports about brain tumor with PWD in children. We report a case of medulloblastoma presented with PWD in a 7-year-old girl. She visited our outpatient clinic because of English dictation performance deterioration. PWD was diagnosed by the otolaryngologist after examinations. Posterior fossa tumor and obstructive hydrocephalus were shown in the magnetic resonance imaging of the brain. The diagnosis of medulloblastoma was then made by pathology.

Localization of sublexical speech perception components

Models of speech perception are in general agreement with respect to the major cortical regions involved, but lack precision with regard to localization and lateralization of processing units. To refine these models we conducted two Activation Likelihood Estimation (ALE) meta-analyses of the neuroimaging literature on sublexical speech perception. Based on foci reported in 23 fMRI experiments, we identified significant activation likelihoods in left and right superior temporal cortex and the left posterior middle frontal gyrus. Sub-analyses examining phonetic and phonological processes revealed only left mid-posterior superior temporal sulcus activation likelihood. A lateralization analysis demonstrated temporal lobe left lateralization in terms of magnitude, extent, and consistency of activity. Experiments requiring explicit attention to phonology drove this lateralization. An ALE analysis of eight fMRI studies on categorical phoneme perception revealed significant activation likelihood in the left supramarginal gyrus and angular gyrus. These results are consistent with a speech processing network in which the bilateral superior temporal cortices perform acoustic analysis of speech and non-speech auditory stimuli, the left mid-posterior superior temporal sulcus performs phonetic and phonological analysis, and the left inferior parietal lobule is involved in detection of differences between phoneme categories. These results modify current speech perception models in three ways: (1) specifying the most likely locations of dorsal stream processing units, (2) clarifying that phonetic and phonological superior temporal sulcus processing is left lateralized and localized to the mid-posterior portion, and (3) suggesting that both the supramarginal gyrus and angular gyrus may be involved in phoneme discrimination.

Auditory-visual speech perception in an adult with aphasia

The evaluation of auditory-visual speech perception is not typically undertaken in the assessment of aphasia; however, treatment approaches utilise bimodal presentations. Research demonstrates that auditory and visual information are integrated for speech perception. The strongest evidence of this cross-modal integration is the McGurk effect. This indirect measure of integration shows that presentation of conflicting tokens may change perception (e.g. auditory /bi/ + visual /gi/ = /di/). The purpose of this study was to investigate the ability of a person with mild aphasia to identify tokens presented in auditory-only, visual-only and auditory-visual conditions. It was hypothesized that performance would be best in the bimodal condition and that presence of the McGurk effect would demonstrate integration of speech information. Findings did not support the hypotheses. It is suspected that successful integration of AV speech information was limited by a perseverative response pattern. This case study suggests the use of bisensory speech information may be impaired in adults with aphasia.

Pure word deafness due to left subcortical lesion: Neurophysiological studies of two patients

OBJECTIVE

This study investigated the auditory processing in two patients with pure word deafness (PWD) using neurophysiological experimental methods.

METHODS

We recorded the auditory brainstem response (ABR), the middle latency auditory-evoked response (MLR) and the auditory-evoked event-related potentials (ERPs) in two patients with PWD after subcortical hemorrhage in the left temporal lobe.

RESULTS

Both patients showed normal response in ABR and abnormality in MLR. The latency of P300 evoked by right-ear stimulation was 51 ms longer in one patient and 26 ms longer in the other patient than that evoked by left-ear stimulation.

CONCLUSIONS

Our results suggested that the prolongation of P300 latency could be caused by the deterioration of auditory stimulus processing and supported the hypothesis that the defect in auditory temporal resolution was an important factor in the development of PWD.

SIGNIFICANCE

This study demonstrated that recordings of ERP with auditory-evoked response such as ABR and MLR are useful to elucidate the deterioration of auditory stimulus processing in patients with PWD.

Central auditory pathologies

This chapter considers specific deficits in auditory processing ('negative' disorders) due to neurological conditions and 'positive' disorders of central auditory processing caused by abnormal activity in central auditory mechanisms. Recent work focuses on the assessment of auditory processing in disorders that are not specifically auditory. In this case, auditory measurement may provide a 'window' into the condition.

Acquired word deafness, and the temporal grain of sound representation in the primary auditory cortex

This paper explores the nature of the processing disorder which underlies the speech discrimination deficit in the syndrome of acquired word deafness following from pathology to the primary auditory cortex. A critical examination of the evidence on this disorder revealed the following. First, the most profound forms of the condition are expressed not only in an isolation of the cerebral linguistic processor from auditory input, but in a failure of even the perceptual elaboration of the relevant sounds. Second, in agreement with earlier studies, we conclude that the perceptual dimension disturbed in word deafness is a temporal one. We argue, however, that it is not a generalized disorder of auditory temporal processing, but one which is largely restricted to the processing of sounds with temporal content in the milliseconds to tens-of-milliseconds time frame. The perceptual elaboration of sounds with temporal content outside that range, in either direction, may survive the disorder. Third, we present neurophysiological evidence that the primary auditory cortex has a special role in the representation of auditory events in that time frame, but not in the representation of auditory events with temporal grains outside that range.