Apraxia and motor dysfunction in corticobasal syndrome.

BACKGROUND: Corticobasal syndrome (CBS) is characterized by multifaceted motor system dysfunction and cognitive disturbance; distinctive clinical features include limb apraxia and visuospatial dysfunction. Transcranial magnetic stimulation (TMS) has been used to study motor system dysfunction in CBS, but the relationship of TMS parameters to clinical features has not been studied. The present study explored several hypotheses; firstly, that limb apraxia may be partly due to visuospatial impairment in CBS. Secondly, that motor system dysfunction can be demonstrated in CBS, using threshold-tracking TMS, and is linked to limb apraxia. Finally, that atrophy of the primary motor cortex, studied using voxel-based morphometry analysis (VBM), is associated with motor system dysfunction and limb apraxia in CBS. METHODS: Imitation of meaningful and meaningless hand gestures was graded to assess limb apraxia, while cognitive performance was assessed using the Addenbrooke's Cognitive Examination - Revised (ACE-R), with particular emphasis placed on the visuospatial subtask. Patients underwent TMS, to assess cortical function, and VBM. RESULTS: In total, 17 patients with CBS (7 male, 10 female; mean age 64.4+/- 6.6 years) were studied and compared to 17 matched control subjects. Of the CBS patients, 23.5% had a relatively inexcitable motor cortex, with evidence of cortical dysfunction in the remaining 76.5% patients. Reduced resting motor threshold, and visuospatial performance, correlated with limb apraxia. Patients with a resting motor threshold <50% performed significantly worse on the visuospatial sub-task of the ACE-R than other CBS patients. Cortical function correlated with atrophy of the primary and pre-motor cortices, and the thalamus, while apraxia correlated with atrophy of the pre-motor and parietal cortices. CONCLUSIONS: Cortical dysfunction appears to underlie the core clinical features of CBS, and is associated with atrophy of the primary motor and pre-motor cortices, as well as the thalamus, while apraxia correlates with pre-motor and parietal atrophy.

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.

Developmental phonagnosia: a selective deficit of vocal identity recognition.

Phonagnosia, the inability to recognize familiar voices, has been studied in brain-damaged patients but no cases due to developmental problems have been reported. Here we describe the case of KH, a 60-year-old active professional woman who reports that she has always experienced severe voice recognition difficulties. Her hearing abilities are normal, and an MRI scan showed no evidence of brain damage in regions associated with voice or auditory perception. To better understand her condition and to assess models of voice and high-level auditory processing, we tested KH on behavioural tasks measuring voice recognition, recognition of vocal emotions, face recognition, speech perception, and processing of environmental sounds and music. KH was impaired on tasks requiring the recognition of famous voices and the learning and recognition of new voices. In contrast, she performed well on nearly all other tasks. Her case is the first report of developmental phonagnosia, and the results suggest that the recognition of a speaker's vocal identity depends on separable mechanisms from those used to recognize other information from the voice or non-vocal auditory stimuli.

Simultanagnosia: when a rose is not red.

Abstract Information regarding object identity ("what") and spatial location ("where/how to") is largely segregated in visual processing. Under most circumstances, however, object identity and location are linked. We report data from a simultanagnosic patient (K.E.) with bilateral posterior parietal infarcts who was unable to "see" more than one object in an array despite relatively preserved object processing and normal preattentive processing. K.E. also demonstrated a finding that has not, to our knowledge, been reported: He was unable to report more than one attribute of a single object. For example, he was unable to name the color of the ink in which words were written despite naming the word correctly. Several experiments demonstrated, however, that perceptual attributes that he was unable to report influenced his performance. We suggest that binding of object identity and location is a limited-capacity operation that is essential for conscious awareness for which the posterior parietal lobe is crucial.

Neural mechanisms of embodiment: asomatognosia due to premotor cortex damage.

BACKGROUND: Patients with asomatognosia generally describe parts of their body as missing or disappeared from corporeal awareness. This disturbance is generally attributed to damage in the right posterior parietal cortex. However, recent neuroimaging and electrophysiological studies suggest that corporeal awareness and embodiment of body parts are instead linked to the premotor cortex of both hemispheres. PATIENT: We describe a patient with asomatognosia of her left arm due to damage in the right premotor and motor cortices. The patient's pathological embodiment for her left arm was associated with mild left somatosensory loss, mild frontal dysfunction, and a behavioral deficit in the mental imagery of human arms. CONCLUSION: Asomatognosia may also be associated with damage to the right premotor cortex.

Deficits of musical timbre perception after unilateral temporal-lobe lesion revealed with multidimensional scaling.

Thirty patients with unilateral temporal lobe excisions and 15 normal control subjects were tested in a task involving judgements of timbre dissimilarity in single tone and melodic conditions. Perceptual correlates of spectral and temporal parameters resulting from changing the number of harmonics and rise-time duration, respectively, were investigated by using a multidimensional scaling technique. The results of subjects with left temporal lobe lesion suggest that they were able to use the spectral and temporal envelopes of tones independently in making perceptual judgements of single tones. In the melodic condition, their results were significantly different from those of normal control subjects, suggesting that left temporal lesions do affect subtle aspects of timbre perception, despite these patients' preserved ability to make discrimination judgements using traditional paradigms. The major finding of this study concerns perceptual ratings obtained by subjects with right temporal lobe lesion, which revealed a disturbed perceptual space in both conditions. The most distorted results were obtained with single tones, in which the temporal parameter was less prominent. Tones were grouped according to their spectral content, but the results did not reflect a coherent underlying perceptual dimension. In general, the data from both patient groups (left lesions and right lesions) showed that the extraction of temporal cues was easier in the melodic than in the single tone condition, suggesting that the different durations and frequencies heard in a musical phrase enhance the importance of certain physical parameters. The findings of the present study replicate and extend previous results showing that timbre perception depends mainly upon the integrity of right neocortical structures, although a contribution of left temporal regions is also apparent. These data also demonstrate that multidimensional techniques are sensitive to more subtle perceptual disturbances that may not be revealed by discrimination paradigms.

Auditory agnosia and auditory spatial deficits following left hemispheric lesions: evidence for distinct processing pathways.

Auditory recognition and auditory spatial functions were studied in four patients with circumscribed left hemispheric lesions. Patient FD was severely deficient in recognition of environmental sounds but normal in auditory localisation and auditory motion perception. The lesion included the left superior, middle and inferior temporal gyri and lateral auditory areas (as identified in previous anatomical studies), but spared Heschl's gyrus, the acoustic radiation and the thalamus. Patient SD had the same profile as FD, with deficient recognition of environmental sounds but normal auditory localisation and motion perception. The lesion comprised the postero-inferior part of the frontal convexity and the anterior third of the temporal lobe; data from non-human primates indicate that the latter are interconnected with lateral auditory areas. Patient MA was deficient in recognition of environmental sounds, auditory localisation and auditory motion perception, confirming that auditory spatial functions can be disturbed by left unilateral damage; the lesion involved the supratemporal region as well as the temporal, postero-inferior frontal and antero-inferior parietal convexities. Patient CZ was severely deficient in auditory motion perception and partially deficient in auditory localisation, but normal in recognition of environmental sounds; the lesion involved large parts of the parieto-frontal convexity and the supratemporal region. We propose that auditory information is processed in the human auditory cortex along two distinct pathways, one lateral devoted to auditory recognition and one medial and posterior devoted to auditory spatial functions.

Multiple-domain dissociation between impaired visual perception and preserved mental imagery in a patient with bilateral extrastriate lesions.

A brain-damaged patient is described whose pattern of performance provides insight into both the functional mechanisms and the neural structures involved in visual mental imagery. The patient became severely agnosic, alexic, achromatopsic and prosopagnosic following bilateral brain lesions in the temporo-occipital cortex. However, her mental imagery for the same visual entities that she could not perceive was perfectly preserved. This clear-cut dissociation held across all the major domains of high-level vision: object recognition, reading, colour and face processing. Our findings, together with other reports on domain-specific dissociations and functional brain imaging studies, provide evidence to support the view that visual perception and visual mental imagery are subserved by independent functional mechanisms, which do not share the same cortical implementation. In particular, our results suggest that mental imagery abilities need not be mediated by early visual cortices.