Brainstem lesions and click lateralization in patients with multiple sclerosis

Discriminating spatialised speech in complex environments in multiple sclerosis

People with multiple sclerosis (pwMS) frequently present with deficits in binaural processing used for sound localization. This study examined spatial release from speech-on-speech masking in pwMS, which involves binaural processing and additional higher level mechanisms underlying streaming, such as spatial attention. 26 pwMS with mild severity (Expanded Disability Status Scale score <3) and 20 age-matched controls listened via headphones to pre-recorded sentences from a standard list presented simultaneously with eight-talker babble. Virtual acoustic techniques were used to simulate sentences originating from 0°, 20°, or 50° on the interaural horizontal plane around the listener whilst babble was presented continuously at 0° azimuth, and participants verbally repeated the target sentence. In a separate task, two simultaneous sentences both containing a colour and number were presented, and participants were required to report the target colour and number. Both competing sentences could originate from 0°, 20°, or 50° on the azimuthal plane. Participants also completed a series of neuropsychological assessments, an auditory questionnaire, and a three-alternative forced-choice task that involved the detection of interaural time differences (ITDs) in noise bursts. Spatial release from masking was observed in both pwMS and controls, as response accuracy in the two speech discrimination tasks improved in the spatially separated conditions (20° and 50°) compared with the co-localised condition. However, pwMS demonstrated significantly less spatial release (18%) than controls (28%) when discriminating colour/number coordinates. At 50° separation, pwMS discriminated significantly fewer coordinates (77%) than controls (89%). In contrast, pwMS had similar performances to controls when sentences were presented in babble, and for the basic ITD discrimination task. Significant correlations between speech discrimination performance and standardized neuropsychological scores were observed across all spatial conditions. Our findings suggest that spatial hearing is likely to be implicated in pwMS, thereby affecting the perception of competing speech originating from various locations.

Impaired Binaural Hearing in Adults: A Selected Review of the Literature

Despite over 100 years of study, there are still many fundamental questions about binaural hearing that remain unanswered, including how impairments of binaural function are related to the mechanisms of binaural hearing. This review focuses on a number of studies that are fundamental to understanding what is known about the effects of peripheral hearing loss, aging, traumatic brain injury, strokes, brain tumors, and multiple sclerosis (MS) on binaural function. The literature reviewed makes clear that while each of these conditions has the potential to impair the binaural system, the specific abilities of a given patient cannot be known without performing multiple behavioral and/or neurophysiological measurements of binaural sensitivity. Future work in this area has the potential to bring awareness of binaural dysfunction to patients and clinicians as well as a deeper understanding of the mechanisms of binaural hearing, but it will require the integration of clinical research with animal and computational modeling approaches.

How to detect and track chronic neurologic sequelae of COVID-19? Use of auditory brainstem responses and neuroimaging for long-term patient follow-up

This review intends to provide an overview of the current knowledge on neurologic sequelae of COVID-19 and their possible etiology, and, based on available data, proposes possible improvements in current medical care procedures. We conducted a thorough review of the scientific literature on neurologic manifestations of COVID-19, the neuroinvasive propensity of known coronaviruses (CoV) and their possible effects on brain structural and functional integrity. It appears that around one third of COVID-19 patients admitted to intensive care units (ICU) for respiratory difficulties exhibit neurologic symptoms. This may be due to progressive brain damage and dysfunction triggered by severe hypoxia and hypoxemia, heightened inflammation and SARS-CoV-2 dissemination into brain parenchyma, as suggested by current reports and analyses of previous CoV outbreaks. Viral invasion of the brain may particularly target and alter brainstem and thalamic functions and, consequently, result in sensorimotor dysfunctions and psychiatric disorders. Moreover, data collected from other structurally homologous CoV suggest that SARS-CoV-2 infection may lead to brain cell degeneration and demyelination similar to multiple sclerosis (MS). Hence, current evidence warrants further evaluation and long-term follow-up of possible neurologic sequelae in COVID-19 patients. It may be particularly relevant to evaluate brainstem integrity in recovered patients, as it is suspected that this cerebral area may particularly be dysfunctional following SARS-CoV-2 infection. Because CoV infection can potentially lead to chronic neuroinflammation and progressive demyelination, neuroimaging features and signs of MS may also be evaluated in the long term in recovered COVID-19 patients.

Multiple sclerosis: Left advantage for auditory laterality in dichotic tests of central auditory processing and relationship of psychoacoustic tests with the Multiple Sclerosis Disability Scale-EDSS

OBJECTIVE

To evaluate the central auditory processing disorders in patients with multiple sclerosis, emphasizing auditory laterality by applying psychoacoustic tests and to identify their relationship with the Multiple Sclerosis Disability Scale (EDSS) functions.

METHOD

Depression scales (HADS), EDSS, and 9 psychoacoustic tests to study CAPD were applied to 26 individuals with multiple sclerosis and 26 controls. Correlation tests were performed between the EDSS and psychoacoustic tests.

RESULTS

Seven out of 9 psychoacoustic tests were significantly different (P<.05); right or left (14/19 explorations) with respect to control. In dichotic digits there was a left-ear advantage compared to the usual predominance of RDD. There was significant correlation in five psychoacoustic tests and the specific functions of EDSS.

CONCLUSION

The left-ear advantage detected and interpreted as an expression of deficient influences of the corpus callosum and attention in multiple sclerosis should be investigated. There was a correlation between psychoacoustic tests and specific EDSS functions.

Absence of Claudin 11 in CNS Myelin Perturbs Behavior and Neurotransmitter Levels in Mice

Neuronal origins of behavioral disorders have been examined for decades to construct frameworks for understanding psychiatric diseases and developing useful therapeutic strategies with clinical application. Despite abundant anecdotal evidence for white matter etiologies, including altered tractography in neuroimaging and diminished oligodendrocyte-specific gene expression in autopsy studies, mechanistic data demonstrating that dysfunctional myelin sheaths can cause behavioral deficits and perturb neurotransmitter biochemistry have not been forthcoming. At least in part, this impasse stems from difficulties in identifying model systems free of degenerative pathology to enable unambiguous assessment of neuron biology and behavior in a background of myelin dysfunction. Herein we examine myelin mutant mice lacking expression of the Claudin11 gene in oligodendrocytes and characterize two behavioral endophenotypes: perturbed auditory processing and reduced anxiety/avoidance. Importantly, these behaviors are associated with increased transmission time along myelinated fibers as well as glutamate and GABA neurotransmitter imbalances in auditory brainstem and amygdala, in the absence of neurodegeneration. Thus, our findings broaden the etiology of neuropsychiatric disease to include dysfunctional myelin, and identify a preclinical model for the development of novel disease-modifying therapies.

Auditory spatial deficits in brainstem disorders

PURPOSE

Brainstem disorders seem to negatively influence the central auditory system, causing spatial hearing deficits.

MATERIAL AND METHODS

We tested 11 patients with brainstem lesions due to ischemic stroke (IS), multiple sclerosis (MS), or cerebellopontine angle tumor (CPAT) together with 50 age- and sex-matched healthy volunteers. We used pure tone audiometry (PTAud), brainstem auditory evoked potentials (BAEPs) and the horizontal minimum audible angle test (HMAAT) for 8 azimuths with binaural stimulation.

RESULTS

The chosen patients and the controls had normal or near normal hearing in PTAud. BAEPs interaural wave I-V latency difference was over 7 times longer in the patients group compared to the controls. Additionally, 9 of the 11 patients (81.1%) had abnormal HMAAT results. The biggest quantitative disturbances in HMAAT were present in the CPAT and the MS patients. The sound localization ability in HMAAT was significantly worse in the patients in 0° azimuth in comparison with the controls, and in 45° and 90° azimuth in patients with auditory pathway involvement compared with the ones without the involvement.

CONCLUSIONS

Our study confirms the strong relationship between various brainstem pathologies and sound localization disability and sheds some light on the complexity of the relationship.

Hearing disorders in brainstem lesions

Auditory processing can be disrupted by brainstem lesions. It is estimated that approximately 57% of brainstem lesions are associated with auditory disorders. However diseases of the brainstem usually involve many structures, producing a plethora of other neurologic deficits, often relegating "auditory symptoms in the background." Lesions below or within the cochlear nuclei result in ipsilateral auditory-processing abnormalities detected in routine testing; disorders rostral to the cochlear nuclei may result in bilateral abnormalities or may be silent. Lesions in the superior olivary complex and trapezoid body show a mixture of ipsilateral, contralateral, and bilateral abnormalities, whereas lesions of the lateral lemniscus, inferior colliculus, and medial geniculate body do not affect peripheral auditory processing and result in predominantly subtle contralateral abnormalities that may be missed by routine auditory testing. In these cases psychophysical methods developed for the evaluation of central auditory function should be employed (e.g., dichotic listening, interaural time perception, sound localization). The extensive connections of the auditory brainstem nuclei not only are responsible for binaural interaction but also assure redundancy in the system. This redundancy may explain why small brainstem lesions are sometimes clinically silent. Any disorder of the brainstem (e.g., neoplasms, vascular disorders, infections, trauma, demyelinating disorders, neurodegenerative diseases, malformations) that involves the auditory pathways and/or centers may produce hearing abnormalities.

Hearing disorders in multiple sclerosis

Multiple sclerosis (MS) is a disease that is both a focal inflammatory and a chronic neurodegenerative disease. The focal inflammatory component is characterized by destruction of central nervous system myelin, including the spinal cord; as such it can impair any central neural system, including the auditory system. While on the one hand auditory complaints in MS patients are rare compared to other senses, such as vision and proprioception, on the other hand auditory tests of precise neural timing are never "silent." Whenever focal MS lesions are detected involving the pontine auditory pathway, auditory tests requiring precise neural timing are always abnormal, while auditory functions not requiring such precise timing are often normal. Azimuth sound localization is accomplished by comparing the timing and loudness of the sound at the two ears. Hence tests of azimuth sound localization must obligatorily involve the central nervous system and particularly the brainstem. Whenever a focal lesion was localized to the pontine auditory pathway, timing tests were always abnormal, but loudness tests were not. Moreover, a timing test that included only high-frequency sounds was very often abnormal, even when there was no detectable focal MS lesion involving the pontine auditory pathway. This test may be a marker for the chronic neurodegenerative aspect of MS, and, as such could be used to complement the magnetic resonance imaging scan in monitoring the neurodegenerative aspect of MS. Studies of MS brainstem lesion location and auditory function have led to advances in understanding how the human brain processes sound. The brain processes binaural sounds independently for time and level in a two-stage process. The first stage is at the level of the superior olivary complex (SOC) and the second at a level rostral to the SOC.

Hemispheric competence for auditory spatial representation

Sound localization relies on the analysis of interaural time and intensity differences, as well as attenuation patterns by the outer ear. We investigated the relative contributions of interaural time and intensity difference cues to sound localization by testing 60 healthy subjects: 25 with focal left and 25 with focal right hemispheric brain damage. Group and single-case behavioural analyses, as well as anatomo-clinical correlations, confirmed that deficits were more frequent and much more severe after right than left hemispheric lesions and for the processing of interaural time than intensity difference cues. For spatial processing based on interaural time difference cues, different error types were evident in the individual data. Deficits in discriminating between neighbouring positions occurred in both hemispaces after focal right hemispheric brain damage, but were restricted to the contralesional hemispace after focal left hemispheric brain damage. Alloacusis (perceptual shifts across the midline) occurred only after focal right hemispheric brain damage and was associated with minor or severe deficits in position discrimination. During spatial processing based on interaural intensity cues, deficits were less severe in the right hemispheric brain damage than left hemispheric brain damage group and no alloacusis occurred. These results, matched to anatomical data, suggest the existence of a binaural sound localization system predominantly based on interaural time difference cues and primarily supported by the right hemisphere. More generally, our data suggest that two distinct mechanisms contribute to: (i) the precise computation of spatial coordinates allowing spatial comparison within the contralateral hemispace for the left hemisphere and the whole space for the right hemisphere; and (ii) the building up of global auditory spatial representations in right temporo-parietal cortices.

Auditory brainstem activity in children with 9–30 months of bilateral cochlear implant use

Bilateral cochlear implants aim to restore binaural processing along the auditory pathways in children with bilateral deafness. We assessed auditory brainstem activity evoked by single biphasic pulses delivered by an apical or basal electrode from the left, right and both cochlear implants in 13 children. Repeated measures were made over the first 9-30 months of bilateral implant use. In children with short or long periods of unilateral implant use prior to the second implantation, Wave eV of the auditory brainstem response was initially prolonged when evoked by the naïve versus experienced side. These differences tended to resolve in children first implanted <3 years of age but not in children implanted at older ages with long delays between implants. Latency differences were projected to persist for longer periods in children with long delays between implants compared with children with short delays. No differences in right versus left evoked eV latency were found in 2 children receiving bilateral implants simultaneously and their response latencies decreased over time. Binaural interaction responses showed effects of stimulating electrode position (responses were more detectable when evoked by an apical than basal pair of implant electrodes), and duration of delay between implants (measured by latency delays). The trends shown here suggest a negative impact of unilateral implant use on bilateral auditory brainstem plasticity.

Math5 expression and function in the central auditory system

The basic helix-loop-helix (bHLH) transcription factor Math5 (Atoh7) is required for retinal ganglion cell (RGC) and optic nerve development. Using Math5-lacZ knockout mice, we have identified an additional expression domain for Math5 outside the eye, in functionally connected structures of the central auditory system. In the adult hindbrain, the cytoplasmic Math5-lacZ reporter is expressed within the ventral cochlear nucleus (VCN), in a subpopulation of neurons that project to medial nucleus of the trapezoid body (MNTB), lateral superior olive (LSO), and lateral lemniscus (LL). These cells were identified as globular and small spherical bushy cells based on their morphology, abundance, distribution within the cochlear nucleus (CN), co-expression of Kv1.1, Kv3.1b and Kcnq4 potassium channels, and projection patterns within the auditory brainstem. Math5-lacZ is also expressed by cochlear root neurons in the auditory nerve. During embryonic development, Math5-lacZ was detected in precursor cells emerging from the caudal rhombic lip from embryonic day (E)12 onwards, consistent with the time course of CN neurogenesis. These cells co-express MafB and are post-mitotic. Math5 expression in the CN was verified by mRNA in situ hybridization, and the identity of positive neurons was confirmed morphologically using a Math5-Cre BAC transgene with an alkaline phosphatase reporter. The hindbrains of Math5 mutants appear grossly normal, with the exception of the CN. Although overall CN dimensions are unchanged, the lacZ-positive cells are significantly smaller in Math5 -/- mice compared to Math5 +/- mice, suggesting these neurons may function abnormally. The auditory brainstem response (ABR) of Math5 mutants was evaluated in a BALB/cJ congenic background. ABR thresholds of Math5 -/- mice were similar to those of wild-type and heterozygous mice, but the interpeak latencies for Peaks II-IV were significantly altered. These temporal changes are consistent with a higher-level auditory processing disorder involving the CN, potentially affecting the integration of binaural sensory information.

Representation of interaural temporal information from left and right auditory space in the human planum temporale and inferior parietal lobe

The localization of low-frequency sounds mainly relies on the processing of microsecond temporal disparities between the ears, since low frequencies produce little or no interaural energy differences. The overall auditory cortical response to low-frequency sounds is largely symmetrical between the two hemispheres, even when the sounds are lateralized. However, the effects of unilateral lesions in the superior temporal cortex suggest that the spatial information mediated by lateralized sounds is distributed asymmetrically across the hemispheres. This paper describes a functional magnetic resonance imaging experiment, which shows that the interaural temporal processing of lateralized sounds produces an enhanced response in the contralateral planum temporale (PT). The response is stronger and extends further into adjacent regions of the inferior parietal lobe (IPL) when the sound is moving than when it is stationary. This suggests that the interaural temporal information mediated by lateralized sounds is projected along a posterior pathway comprising the PT and IPL of the respective contralateral hemisphere. The differential responses to moving sounds further revealed that the left hemisphere responded predominantly to sound movement within the right hemifield, whereas the right hemisphere responded to sound movement in both hemifields. This rightward asymmetry parallels the asymmetry associated with the allocation of visuo-spatial attention and may underlie unilateral auditory neglect phenomena.

Preserved use of spatial cues for sound segregation in a case of spatial deafness

Auditory spatial cues contribute to sound localisation and to sound object segregation. We have investigated these capacities in a patient (NM) who complained having difficulties to localise sounds in everyday life after a right temporo-parieto-frontal ischemic lesion. Two groups of tasks were used, in which spatial dimension was simulated by interaural time differences (ITD): (i) active localisation of stationary or moving sound targets, and (ii) sound segregation on the basis of spatial cues. This latter included a spatial release from masking paradigm and two ITD diotic tasks. NM failed to localise stationary and moving sounds: she perceived all the stimuli at the centre of the head, and could not differentiate stationary from moving targets. In contrast, NM was able to use ITD cues to segregate simultaneous sound sources in the spatial-release-from-masking paradigm and in ITD diotic tasks.These results suggest that sound localisation and sound object segregation based on spatial cues do not rely on the same mechanisms.

Characterization of the human superior olivary complex by calcium binding proteins and neurofilament H (SMI-32)

This study provides a morphologic characterization of the human superior olivary complex as revealed by immunohistochemistry by using antibodies against the calcium binding proteins parvalbumin, calbindin, calretinin, and the nonphosphorylated neurofilament H SMI-32. By combining these markers, it was possible to establish the neuronal architecture and details of the morphologic organization (including axonal terminals) of the different nuclei. The medial superior olivary nucleus is formed by a sheet of parallel-oriented cells. A clear segregation of axon terminals was noticed on the medially and laterally oriented dendrites of the mostly bipolar neurons. The lateral superior olivary nucleus lacked a distinct nuclear shape but was formed by several patches of rather irregularly arranged neurons. Calretinin or parvalbumin immunoreactive afferent terminals were observed which contacted somata or dendrites of these neurons. The immunolabeling also revealed the boundaries of the dorsal periolivary nucleus and morphologic detail of its neurons. A coherent nuclear structure that could be addressed as the medial nucleus of the trapezoid body was not identified by any single one or by combinations of the markers used. The data were also used to establish a three-dimensional-reconstruction of the three major subnuclei of the superior olivary complex. The results are discussed with respect to the possible role of the superior olivary complex in the processing of spatial acoustic information in the azimuthal plane.

Mapping lateralization of click trains in younger and older populations

The main purpose of this study was to describe and compare lateralization of earphone-presented stimuli in younger and older individuals. Lateralization functions, relating perceived location to either interaural time differences (ITDs) or interaural level differences (ILDs) were determined for 78 subjects, aged 21-88 years, who responded by pressing one of nine keys to indicate the perceived location of the stimulus. All subjects were healthy, without any history of hearing loss or ear surgery and within the normal pure tone audiometric range for their age group. Interaural pure tone and click thresholds did not differ by more than 5 dB across ears. The ILD lateralization functions, ranging from 10 dB favoring the left ear to 10 dB favoring the right ear were linear. In contrast, the ITD lateralization functions were S-shaped with a clear linear component ranging from 750 micros favoring one ear to 750 micros favoring the other ear and with an asymptote from 750 micros to 1 ms. The same general shape of the ITD and ILD lateralization functions was found at all ages, but the linear slope of the ITD lateralization function became shallower with age. The ability to discriminate midline-located click trains (ITD and ILD=0) from ITD-lateralized click trains deteriorated with age, while the comparable ability to discriminate ILD-lateralized click trains did not change significantly with age. The data support two general conclusions. First there seems to be an overall reduction in the range of ITD-based lateralization due to aging. Second, there is a greater reduction in sensitivity due to aging in changes from the perceived midline position (ITD and ILD=0) when ITD is manipulated than when ILD is manipulated.

Functional role of the human inferior colliculus in binaural hearing

Psychophysical experiments were carried out in a rare case involving a 48 year old man (RJC) with a small traumatic hemorrhage of the right dorsal midbrain, including the inferior colliculus (IC). RJC had normal audiograms bilaterally, but there was a marked decrease in wave V amplitude on click-evoked brainstem auditory evoked potentials following left ear stimulation. RJC demonstrated a deficit in sound localization identification when the loudspeakers lay within the auditory hemifield contralateral to his IC lesion. Errors showed a consistent bias towards the hemifield ipsilateral to the lesion. Echo suppression was abnormally weak compared with that seen in control subjects, but only for sources contralateral to the lesion. Finally, speech intelligibility tests showed normal ability to benefit from spatial separation of target and competing speech sources. These results suggest that: (1) localizing sounds within a given hemifield relies on the integrity of the contralateral IC, (2) unilateral IC lesions give the illusion that sound sources in the 'bad' hemifield are displaced towards the 'good' hemifield, (3) the IC mediates aspects of echo suppression, and (4) lesion in the IC does not impede spatial release from masking in speech intelligibility, possibly due to that ability being more heavily mediated by cortical regions.

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.

A model for sound lateralization

Recent studies of multiple sclerosis (MS) and stroke patients suggested a correlation between two patterns of abnormal performance in lateralization tasks and two sites of pontine lesions. Most patients who had lesions below or at the superior olivary complex (SOC) perceived all interaural differences in binaural stimuli as small, while most patients who had lesions above the SOC perceived all interaural differences as large. The two abnormal performance patterns occurred for interaural time differences (ITD) and/or for interaural level differences (ILD). The present model proposes a multi-level hierarchical brainstem structure that estimates ITD and ILD. The first level seeks dissimilarity between the left and right inputs and a second level looks for similarity between the two sides' inputs. Each level is modeled as an ensemble of neural arrays in which each unit performs a logic or arithmetic function. The inputs are simulations of auditory nerve responses to broadband stimuli. Simulations yield good correspondence to the effect of both locations of pontine lesions on binaural performance.

Organization of the human superior olivary complex

The distinctive morphology of the human superior olivary complex reflects its primate origins, but functional evidence suggests that it plays a role in auditory spatial mapping which is similar to olivary function in other mammalian species. It seems likely that the well-developed human medial olivary nucleus is the basis for extraction of interaural time and phase differences. The much smaller human lateral olivary nucleus probably functions in analysis of interaural differences in frequency and intensity, but the absence of a human nucleus of the trapezoid body implies some difference in the mechanisms of this function. A window on human olivary function is provided by the evoked auditory brainstem response (ABR), including its binaural interaction component (BIC). Anatomical, electrophysiological, and histopathological studies suggest that ABR waves IV and V are generated by axonal pathways at the level of the superior olivary complex. Periolivary cell groups are prominent in the human olivary complex. The cell groups located medial, lateral, and dorsal are similar to periolivary nuclei of other mammals, but the periolivary nucleus at the rostral pole of the human olivary complex is very large by mammalian standards. Within the periolivary system, immunostaining for neurotransmitter-related substances allows us to identify populations of medial and lateral olivocochlear neurons. The human olivocochlear system is unique among mammals in the relatively small size of its lateral efferent component. Some consideration is given to the idea that the integration provided by periolivary cell groups, particularly modulation of the periphery by the olivocochlear system, is an extension of the spatial mapping function of the main olivary nuclei.

Auditory dysfunction in stroke

The auditory and vestibular systems share the same end organ and cranial nerve, yet vestibular signs and symptoms are common with stroke, whereas hearing disturbances are much less frequent. Several reasons would appear to account for this striking dissimilarity. One is that the auditory pathway is less ubiquitous than the vestibular pathways. The likelihood that a stroke involves the auditory pathway is, therefore, less on this basis alone. A second difference, to our knowledge not previously reported, is that the auditory pathway is often spared by the most common strokes. This is because major parts of the auditory pathway, such as the cochlear nucleus, inferior colliculus and medial geniculate body, have multiple sources of blood supply. A third well-recognized factor is the redundancy of the central auditory system and its strong bilateral representation above the level of the cochlear nuclei. Consequently, rostral to the cochlear nuclei gross deficits in hearing, such as those measured by standard pure-tone audiometry and speech discrimination, only occur if lesions are bilateral. Furthermore, widespread bilateral lesions of the auditory system typically render the patient unable to respond or are incompatible with life. In contrast, language disorders are more frequent because language is usually unilaterally represented in the cortex. Certainly, cerebral stroke often includes the auditory system, resulting in various types of auditory disorders, but most hemispherical lesions produce subtle hearing dysfunctions that can only be detected with sophisticated psychoacoustic and electrophysiological testing. The purpose of this review is to provide an overview of the auditory system and its blood supply and to review how auditory processing can be affected by stroke. Psychoacoustic and electrophysiological test procedures for identifying lesions in the central auditory system are described. The literature of hearing disorders due to stroke is reviewed and illustrative cases are presented.

Sound lateralization and interaural discrimination. Effects of brainstem infarcts and multiple sclerosis lesions

Subjects with brainstem lesions due to either an infarct or multiple sclerosis (MS) underwent two types of binaural testing (lateralization testing and interaural discrimination) for three types of sounds (clicks and high and low frequency narrow-band noise) with two kinds of interaural differences (level and time). Two major types of abnormalities were revealed in the lateralization performances: perception of all stimuli, regardless of interaural differences (time and/or level) in the center of the head (center-oriented), or lateralization of all stimuli to one side or the other of the head (side-oriented). Similar patterns of abnormal lateralization (center-oriented and side-oriented) occurred for MS and stroke patients. A subject's pattern of abnormal lateralization testing was the same regardless of the type of stimulus or type of interaural disparity. Lateralization testing was a more sensitive test than interaural discrimination testing for both types of subjects. Magnetic resonance image (MRI) scanning in three orthogonal planes of the brainstem was used to detect lesions. A semi-automated algorithm superimposed the auditory pathway onto each MRI section. Whenever a lesion overlapped the auditory pathway, some binaural performance was abnormal and vice versa. Given a lateralization test abnormality, whether the pattern was center-oriented or side-oriented was mainly determined by lesion site. Center-oriented performance was principally associated with caudal pontine lesions and side-oriented performance with lesions rostral to the superior olivary complex. For lesions restricted to the lateral lemniscus and/or inferior colliculus, whether unilateral or bilateral, just noticeable differences (JNDs) were nearly always abnormal, but for caudal pontine lesions JNDs could be normal or abnormal. MS subjects were more sensitive to interaural time delays than interaural level differences particularly for caudal pontine lesions, while stroke patients showed no differential sensitivity to the two kinds of interaural differences. These results suggest that neural processing of binaural stimuli is multilevel and begins with independent interaural time and level analyzers in the caudal pons.

Effects of localized pontine lesions on auditory brain-stem evoked potentials and binaural processing in humans

OBJECTIVES AND METHODS

Four sets of measurements were obtained from 11 patients (44-80 years old) with small, localized pontine lesions due to vascular disease: (1) Monaural auditory brain-stem evoked potentials (ABEPs; peaks I to VI); (2) Binaural ABEPs processed for their binaural interaction components (BICs) in the latency range of peaks IV to VI; (3) magnetic resonance imaging (MRI) of the brain-stem; and (4) psychoacoustics of interaural time disparity measures of binaural localization. ABEPs and BICs were analyzed for peak latencies and interpeak latency differences. Three-channel Lissajous' trajectories (3-CLTs) were derived for ABEPs and BICs and the latencies and orientations of the equivalent dipoles of ABEP and BICs were inferred from them.

RESULTS

Intercomponent latency measures of monaurally evoked ABEPs were abnormal in only 3 of the 11 patients. Consistent correlations between sites of lesion and neurophysiological abnormality were obtained in 9 of the 11 patients using 3-CLT measures of BICs. Six of the 11 patients had absence of one or more BIC components. Seven of the 11 had BICs orientation abnormality and 3 had latency abnormalities. Trapezoid body (TB) lesions (6 patients) were associated with an absent (two patients with ventral-caudal lesions) or abnormal (one patient with ventral-rostral lesions) dipole orientation of the first component (at the time of ABEPs IV), and sparing of this component with midline ventral TB lesions (two patients). A deviant orientation of the second BICs component (at the time of ABEPs V) was observed with ventral TB lesions. Psychoacoustic lateralization in these patients was biased toward the center. Rostral lateral lemniscus (LL) lesions (3 patients) were associated with absent (one patient) or abnormal (two patients) orientation of the third BICs component (at the time of ABEPs VI); and a side-biased lateralization with behavioral testing.

CONCLUSIONS

These results indicate that: (1) the BICs component occurring at the time of ABEPs peak IV is dependent on ventral-caudal TB integrity; (2) the ventral TB contributes to the BICs component at the time of ABEPs peak V; and (3) the rostral LL is a contributing generator of the BICs component occurring at the time of ABEP peak VI.

Lateralization and binaural discrimination of patients with pontine lesions

Lateralization and just-noticeable difference (jnd) measurements relative to the center were tested in a large group of patients with pontine lesions caused either by stroke or multiple sclerosis. Stimuli included binaural clicks, and low- and high-frequency narrow-band noise bursts. Two major types of abnormalities were revealed in the lateralization performances: perception of all stimuli, regardless of interaural differences (time and/or level) in the center of head (center-oriented), or lateralization of all stimuli to one side or the other of the head (side-oriented). The only significant correlation between jnd and lateralization performances was that an elevated jnd was always manifested in abnormal lateralization, while abnormality in lateralization did not necessarily indicate an abnormal jnd. Center-oriented lateralization was observed either for both interaural differences or only for one of them, and was found in both MS and stroke patients. All side-oriented stroke patients were similarly unable to center binaural stimuli for both time and level cues, whereas only one MS patient had this abnormality for interaural time differences, while his level performance was normal. More abnormalities were detected in the narrow band stimuli tests, although in some cases performance was more degraded for click stimuli. Lateralization tasks with high-frequency stimuli were more sensitive detectors of abnormality than jnd for any kind of stimulus, or lateralization tasks with low-frequency stimuli or clicks.

Evidence for separate processing in the human brainstem of interaural intensity and temporal disparities for sound lateralization

Sound lateralization can be induced by interaural intensity disparities (IIDs) or by interaural temporal disparities (ITDs). The purpose of this study was to indicate whether IIDs and ITDs are processed by the same central units that detect interaural disparity in timing of afferent activity. If sound lateralization to intensity and time cues was determined by the same afferent latency disparity detectors in the brainstem, lateralization would be the same, regardless of whether latency disparity was induced by IIDs or ITDs. Moreover, the disparity detectors, and thus their dipole equivalents, would be the same for equal lateralizations, whether induced by IIDs or ITDs. Auditory brainstem evoked potentials (ABEPs) were recorded in response to monaural and binaural clicks, with a variety of IIDs and ITDs. Peak II (proximal auditory nerve activity), peak III (input to the superior olivary complex), and binaural interaction components (BICs) BeI and BeII (binaurally activated upper pons) were identified and their latencies measured. The psychophysical lateralization of the clicks (in cm from vertex) was also measured in response to the same binaural stimuli. The correlations between interaural afferent latency disparities (difference in corresponding peak latencies originating in each ear) and psychophysical click lateralization were calculated. Similarly, the correlations with click lateralization of the BICs equivalent dipole latency as well as orientation change (relative to symmetrical clicks) were determined. A strong correlation with lateralization was found for peaks II and III latency disparities, with steeper slopes for IIDs than for ITDs. Moreover, binaural activity across the same lateralizations differed between IIDs and ITDs. These results, therefore, indicate that interaural time and intensity cues are processed by separate systems in the brainstem, both at the afferent convergence level and after interaural disparities are determined.

Evidence for spatio-topic organization of binaural processing in the human brainstem

Three-channel Lissajous' trajectories (3-CLT) of the binaural interaction (BI) in auditory brainstem evoked potentials (ABEP) were derived from 13 normally and symmetrically hearing adults by subtracting the response to binaural clicks from the algebraic sum of monaural responses. ABEPs were recorded from four channels, three of them orthonormal to each other, in response to alternating polarity clicks, presented at a rate of 11/s with interaural time differences (ITD) of 0.2, 0.4 and 1.0 ms and an intensity of 65 dB nHL, or isochronic to both ears with interaural intensity differences (IIDs) of 5, 10 and 15 dB (65 dB nHL +/- 2.5, 5.0 and 7.5 dB, respectively). All 3-CLTs included 6 planar segments (labeled BdI, BdII, BdIII, BeI, BeII and Bf). Amplitudes of 3-CLT BI components were not significantly affected by increasing ITDs and IIDs, but latencies of all components increased significantly. The most remarkable finding was a significant change in apex orientations of BeI and BeII of the BI 3-CLT across stimulus conditions. The changes in BeI and BeII apex orientations, across stimulus conditions, may reflect differences in the anatomical representation of activity evoked by differently lateralized sounds. We suggest that this may indicate spatio-topic organization in the human brainstem.

Auditory evoked potentials in multiple sclerosis: correlation with magnetic resonance imaging

The present study addresses issues regarding the location of neural sources (i.e. generators) of human auditory evoked potentials (AEPs), and the pattern of neural conduction in the auditory pathway. AEPs were recorded from fifteen patients with multiple sclerosis (MS) and compared to normals. The recordings included auditory brainstem responses (ABRs), mid-latency responses (MLRs), and long-latency responses (LLRs). AEP latency abnormalities were related to the locus of demyelinating lesions, as determined by magnetic resonance imaging (MRI) scans. The data demonstrated several anatomical patterns relating abnormal ABR wave intervals and abnormal MRI signals. From these patterns specific loci for ABR neural sources in the brainstem might be postulated. In addition, the earlier the ABR waves, the more unilateral the abnormalities appeared, suggesting bilateral sources for later waves. The MLRs were highly correlated with ABR wave V and were associated with greater abnormality in MRI signals in midbrain and forebrain regions. In general, patients with abnormal LLRs also had widespread AEP and MRI abnormalities, supporting a multiple source approach for the N1 wave of the LLRs. The observation that LLRs were only abnormal in the presence of bilateral ABR abnormalities suggests a cross wiring which would serve as a compensatory mechanism for unilateral disturbances. The AEP data showed dissociation between early and late wave abnormalities, thus supporting parallel channels for neural conduction in the central auditory system. Such a model calls for some degree of independence of AEP generators along the auditory pathway.

Lateralization and discrimination of dichotic clicks: evidence from patients with brainstem lesions and normal cohorts

The ability to lateralize and discriminate dichotic clicks was tested in multiple sclerosis patients with normal audiograms and in normal cohorts. Lateral position spread over a greater range with interaural level differences than with interaural time differences, and was related to the two asymmetries by different functions. Measures of binaural acuity were inversely related to the slopes of the two functions. One group of patients performed normally with both types of interaural asymmetry, another group performed normally only with level differences; a third group of patients could not perform normally with either.