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Casilio M, Kasdan AV, Schneck SM, Entrup JL, Levy DF, Crouch K, Wilson SM. Situating word deafness within aphasia recovery: A case report. Cortex 2024; 173:96-119. [PMID: 38387377 PMCID: PMC11073474 DOI: 10.1016/j.cortex.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/02/2023] [Accepted: 12/26/2023] [Indexed: 02/24/2024]
Abstract
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.
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Affiliation(s)
| | - Anna V Kasdan
- Vanderbilt University Medical Center, Nashville, TN, USA; Vanderbilt Brain Institute, TN, USA
| | | | | | - Deborah F Levy
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kelly Crouch
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen M Wilson
- Vanderbilt University Medical Center, Nashville, TN, USA; School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
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Wang R, Lin J, Li Y. Response to "The Neurovascular Coupling Concept Does Not Sufficiently Explain the Pathophysiology of Stroke-Like Lesions". J Magn Reson Imaging 2023. [PMID: 37966890 DOI: 10.1002/jmri.29133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023] Open
Affiliation(s)
- Rong Wang
- Department of Radiology, HuaShan Hospital, Fudan University, Shanghai, China
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Jie Lin
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yuxin Li
- Department of Radiology, HuaShan Hospital, Fudan University, Shanghai, China
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
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Esen Aydin A, Aydin S, Bilgin B, Mirkhasilova M, Bayramli N, Tanriover N. Microsurgical anatomy of the auditory radiations: revealing the enigmatic acoustic pathway from a surgical viewpoint. J Neurosurg 2022; 138:1443-1456. [PMID: 36115054 DOI: 10.3171/2022.7.jns22247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 07/15/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The thalamocortical projections of the auditory system have not been detailed via microanatomical fiber dissections from a surgical viewpoint. The aim of this study was to delineate the course of the auditory radiations (ARs) from the medial geniculate body to their final destination in the auditory cortex. The authors' additional purpose was to display the relevant neural structures in relation to their course en route to Heschl's gyrus. METHODS White matter fibers were dissected layer by layer in a lateral-to-medial, inferolateral-to-superomedial, and inferior-to-superior fashion. RESULTS The origin of ARs just distal to the medial geniculate body was revealed following the removal of the parahippocampal gyrus, cingulum bundle, and mesial temporal structures, in addition to the lateral geniculate body. Removing the fimbria, stria terminalis, and the tail of the caudate nucleus along the roof of the temporal horn in an inferior-to-superior direction exposed the lateral compartment of the sublenticular segment of the internal capsule as the predominant obstacle that prevents access to the ARs. The ARs were initially obscured by the inferolaterally located temporopulvinar tract of Arnold, and their initial course passed posterolateral to the temporopontine fascicle of Türck. The ARs subsequently traversed above the temporopulvinar fibers in a perpendicular manner and coursed in between the optic radiations at the sensory intersection region deep to the inferior limiting sulcus of insula. The distal part of the ARs intermingled with the fibers of the anterior commissure and inferior fronto-occipital fasciculus during its ascent toward Heschl's gyrus. The ARs finally projected to a large area over the superior temporal gyrus, extending well beyond the anteroposterior boundaries of the transverse temporal gyri. CONCLUSIONS The ARs can be appreciated as a distinct fiber bundle ascending between the fibers of the sublenticular segment of the internal capsule and traversing superiorly along the roof of the temporal horn by spanning between the optic radiations. Our novel findings suggest potential disruption of the ARs' integrity during transsylvian and transtemporal approaches along the roof of the temporal horn toward the mesial temporal lobe. The detailed 3D understanding of the ARs' relations and awareness of their course may prove helpful to secure surgical interventions to the region.
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Affiliation(s)
- Aysegul Esen Aydin
- 1Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul.,2Department of Neurosurgery, Arnavutkoy State Hospital, Istanbul
| | - Seckin Aydin
- 1Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul.,3Department of Neurosurgery, Okmeydani Training and Research Hospital, University of Health Sciences, Istanbul
| | - Berra Bilgin
- 1Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul.,4Department of Neurosurgery, Tokat State Hospital, Tokat
| | - Muyassar Mirkhasilova
- 1Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul.,5Department of Neurosurgery, İstanbul Demiroglu Bilim University, Gayrettepe Florence Nightingale Hospital, Istanbul; and
| | - Nicat Bayramli
- 1Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul
| | - Necmettin Tanriover
- 1Department of Neurosurgery, Microsurgical Neuroanatomy Laboratory, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul.,6Department of Neurosurgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Silva G, Gonçalves R, Taveira I, Mouzinho M, Osório R, Nzwalo H. Stroke-Associated Cortical Deafness: A Systematic Review of Clinical and Radiological Characteristics. Brain Sci 2021; 11:1383. [PMID: 34827382 PMCID: PMC8615419 DOI: 10.3390/brainsci11111383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Stroke is the leading cause of cortical deafness (CD), the most severe form of central hearing impairment. CD remains poorly characterized and perhaps underdiagnosed. We perform a systematic review to describe the clinical and radiological features of stroke-associated CD. METHODS PubMed and the Web of Science databases were used to identify relevant publications up to 30 June 2021 using the MeSH terms: "deafness" and "stroke", or "hearing loss" and "stroke" or "auditory agnosia" and "stroke". RESULTS We found 46 cases, caused by bilateral lesions within the central auditory pathway, mostly located within or surrounding the superior temporal lobe gyri and/or the Heschl's gyri (30/81%). In five (13.51%) patients, CD was caused by the subcortical hemispheric and in two (0.05%) in brainstem lesions. Sensorineural hearing loss was universal. Occasionally, a misdiagnosis by peripheral or psychiatric disorders occurred. A few (20%) had clinical improvement, with a regained oral conversation or evolution to pure word deafness (36.6%). A persistent inability of oral communication occurred in 43.3%. A full recovery of conversation was restricted to patients with subcortical lesions. CONCLUSIONS Stroke-associated CD is rare, severe and results from combinations of cortical and subcortical lesions within the central auditory pathway. The recovery of functional hearing occurs, essentially, when caused by subcortical lesions.
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Affiliation(s)
- Gracinda Silva
- Faculty of Medicine and Biomedical Sciences, Campus de Gambelas, University of Algarve, 8005-139 Faro, Portugal; (G.S.); (M.M.); (R.O.)
| | - Rita Gonçalves
- Southern Physical Medicine and Rehabilitation Center, University Hospital Center of Algarve, 8150-022 São Brás de Alportel, Portugal;
| | - Isabel Taveira
- Intensive Care Unit, University Hospital Center of Algarve, Rua Leão Penedo, 8000-386 Faro, Portugal;
| | - Maria Mouzinho
- Faculty of Medicine and Biomedical Sciences, Campus de Gambelas, University of Algarve, 8005-139 Faro, Portugal; (G.S.); (M.M.); (R.O.)
| | - Rui Osório
- Faculty of Medicine and Biomedical Sciences, Campus de Gambelas, University of Algarve, 8005-139 Faro, Portugal; (G.S.); (M.M.); (R.O.)
- Stroke Unit, University Hospital Center of Algarve, Rua Leão Penedo, 8000-386 Faro, Portugal
| | - Hipólito Nzwalo
- Faculty of Medicine and Biomedical Sciences, Campus de Gambelas, University of Algarve, 8005-139 Faro, Portugal; (G.S.); (M.M.); (R.O.)
- Stroke Unit, University Hospital Center of Algarve, Rua Leão Penedo, 8000-386 Faro, Portugal
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Akiyoshi R, Shindo M, Kaga K. Subcortical deafness as a subtype of auditory agnosia after injury of bilateral auditory radiations caused by two cerebrovascular accidents - normal auditory brainstem responses with I-VII waves and abolished consciousness of hearing. Acta Otolaryngol 2021; 141:374-380. [PMID: 33573440 DOI: 10.1080/00016489.2020.1871510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND In central auditory disorders caused by damage of the cerebral hemispheres, there are cortical deafness and auditory agnosia. Although clinical cases of cortical deafness have been reported, little is known about the hearing problems and localized lesions associated with cortical deafness. AIMS/OBJECTIVES The aims of our research are to elucidate lesion sites associated with cortical deafness and to clarify why patients with cerebral lesions are not aware of any sound at all. MATERIALS AND METHODS Three patients diagnosed as having total loss of hearing participated in this study. We conducted pure-tone audiometry, speech audiometry, distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR), and brain magnetic resonance imaging (MRI) to diagnose cortical deafness with aphasia tests of these patients. RESULTS Our studies showed that waves VI and VII as well as waves I to V have normal peak latencies in ABRs in all three patients. In brain MRI, we found complete damage of proximal parts of bilateral auditory radiations in the three patients. CONCLUSIONS We propose 'subcortical deafness' as a subtype of auditory agnosia.
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Affiliation(s)
- Ryohei Akiyoshi
- National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
- Department of Otorhinolaryngology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Mitsuko Shindo
- National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
- Speech-Language-Hearing Therapist Department of Social Welfare, Faculty of Humanities and Social Sciences, Showa Women’s University, Tokyo, Japan
| | - Kimitaka Kaga
- National Institute of Sensory Organs, National Tokyo Medical Center, Tokyo, Japan
- Department of Otolaryngology, Kamio Memorial Hospital, Tokyo, Japan
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Lachowska M, Pastuszka A, Sokołowsk J, Szczudlik P, Niemczyk K. Cortical Deafness Due to Ischaemic Strokes in Both Temporal Lobes. J Audiol Otol 2020; 25:163-170. [PMID: 33327707 PMCID: PMC8311059 DOI: 10.7874/jao.2020.00269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 09/15/2020] [Indexed: 01/21/2023] Open
Abstract
Cortical deafness is a clinical rarity whereby a patient is unresponsive to all types of sounds despite the preserved integrity of the peripheral hearing organs. In this study, we present a patient who suddenly lost his hearing following ischaemic infarcts in both temporal lobes with no other neurological deficits. The CT confirmed damage to the primary auditory cortex (Heschl’s gyrus) of both hemispheres. Initially, the patient was unresponsive to all sounds, however, he regained some of the auditory abilities during 10 months follow up. Pure tone threshold improvement from complete deafness to the level of moderate hearing loss in the right ear and severe in the left was observed in pure tone audiometry. Otoacoustic emissions, auditory brainstem responses, and acoustic reflex findings showed normal results. The middle and late latency potential results confirmed objectively the improvement of the patient’s hearing, however, after 10 months still, they were somewhat compromised on both sides. In speech audiometry, there was no comprehension of spoken words neither at 3 nor at 10 months. The absent mismatch negativity confirmed above mentioned comprehension deficit. The extensive auditory electrophysiological testing presented in this study contributes to the understanding of the neural and functional changes in cortical deafness. It presents the evolution of changes after ischaemic cerebrovascular event expressed as auditory evoked potentials starting from short through middle and long latency and ending with event-related potentials and supported by neuroimaging.
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Affiliation(s)
- Magdalena Lachowska
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Pastuszka
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Jacek Sokołowsk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Szczudlik
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | - Kazimierz Niemczyk
- Department of Otorhinolaryngology Head and Neck Surgery, Medical University of Warsaw, Warsaw, Poland
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