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The functional anatomy of central auditory processing.

Cope TE, Baguley DM, Griffiths TD - Pract Neurol (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Neuroscience, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Cambridge, UK.

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Disorders of audition stand at a crossroads between neurology, audiology, psychiatry and ENT... The aim of this ‘How to understand it’ article is to demystify central auditory disorders for neurologists, and to show that they can be assessed like any other neurological symptom, based on a consideration of the anatomy and physiology of the auditory pathway... To illustrate this we describe the case history of a patient who had lost the ability to recognise and appreciate music who presented to an audiology clinician (DMB), who then sought neurology support (TEC, TDG)... After the second incident, he pulled over and called an ambulance, as he felt ‘disorientated’... The ambulance crew found him to be confused and complaining of headache and nausea, so brought him to hospital... This coincided with a gradual improvement in speech reception threshold (the minimum volume at which a patient can understand 50% of simple consonant-vowel-consonant words)... More detailed testing of speech perception 4 years after the second event found a significantly impaired ability to distinguish minimal pairs of real words (eg, bear vs pear) but excellent performance distinguishing words from non-words (eg, bus vs mus)... The time structure of sound at the level of 10s of milliseconds is a critical feature relevant to speech and music perception... He was almost completely unable to detect frequency modulation at a rate of 40 Hz that is usually heard as a roughness (unmeasurably poor performance)... Tests of timing analysis in the 100s of milliseconds range found only mild deficits... Because it is the first point of convergence of the auditory pathway, lesions of the brainstem also commonly lead to problems with integrating the inputs of both ears for spatial sound analysis... In our patient, his profound deficit for detecting acoustic features over timescales of milliseconds or 10s of milliseconds correctly localises the lesion to the auditory nerve or brainstem nuclei... Multiple sclerosis is a common cause of brainstem lesions, and the efferent auditory pathway can be abnormal even with a normal MRI... Patients with aphasia resulting from stroke or neurodegeneration have significant difficulties with the processing of non-verbal sounds.

No MeSH data available.


Unenhanced CT scan of head at the time of the first infarction. The area of haemorrhage involves almost the whole right temporal lobe, and extends into right parietal regions.
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PRACTNEUROL2014001073F1: Unenhanced CT scan of head at the time of the first infarction. The area of haemorrhage involves almost the whole right temporal lobe, and extends into right parietal regions.

Mentions: He suffered two low-speed road traffic accidents in a single journey on the way to work. The first was nose-to-tail, as he failed to see the car in front stop in traffic, and the second was nose-to-nose with a parked car. After the second incident, he pulled over and called an ambulance, as he felt ‘disorientated’. The ambulance crew found him to be confused and complaining of headache and nausea, so brought him to hospital. Initial physical examination showed no injuries but his blood pressure was 230/120 mm Hg. Neurological examination identified a left upper motor neurone facial palsy with preserved limb power, left-sided sensory and visual neglect, left-sided hyper-reflexia and left extensor plantar response. Immediate unenhanced CT of the head showed an extensive lobar haemorrhage, involving most of the right temporal lobe with some parietal lobe extension (figure 1). Digital subtraction angiography of brain was normal. He required 10 days in the high-dependency unit, primarily to control his elevated blood pressure, followed by rehabilitation on the stroke ward. He was discharged on day 28 with residual left hemianopia/neglect, and eventually made it back to work on reduced duties. Sometime later, 24-h ambulatory blood pressure monitoring was normal while taking amlodipine and ramipril. He described no new symptoms related to his hearing after the first episode.


The functional anatomy of central auditory processing.

Cope TE, Baguley DM, Griffiths TD - Pract Neurol (2015)

Unenhanced CT scan of head at the time of the first infarction. The area of haemorrhage involves almost the whole right temporal lobe, and extends into right parietal regions.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4518744&req=5

PRACTNEUROL2014001073F1: Unenhanced CT scan of head at the time of the first infarction. The area of haemorrhage involves almost the whole right temporal lobe, and extends into right parietal regions.
Mentions: He suffered two low-speed road traffic accidents in a single journey on the way to work. The first was nose-to-tail, as he failed to see the car in front stop in traffic, and the second was nose-to-nose with a parked car. After the second incident, he pulled over and called an ambulance, as he felt ‘disorientated’. The ambulance crew found him to be confused and complaining of headache and nausea, so brought him to hospital. Initial physical examination showed no injuries but his blood pressure was 230/120 mm Hg. Neurological examination identified a left upper motor neurone facial palsy with preserved limb power, left-sided sensory and visual neglect, left-sided hyper-reflexia and left extensor plantar response. Immediate unenhanced CT of the head showed an extensive lobar haemorrhage, involving most of the right temporal lobe with some parietal lobe extension (figure 1). Digital subtraction angiography of brain was normal. He required 10 days in the high-dependency unit, primarily to control his elevated blood pressure, followed by rehabilitation on the stroke ward. He was discharged on day 28 with residual left hemianopia/neglect, and eventually made it back to work on reduced duties. Sometime later, 24-h ambulatory blood pressure monitoring was normal while taking amlodipine and ramipril. He described no new symptoms related to his hearing after the first episode.

View Article: PubMed Central - PubMed

Affiliation: Department of Clinical Neuroscience, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Cambridge, UK.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Disorders of audition stand at a crossroads between neurology, audiology, psychiatry and ENT... The aim of this ‘How to understand it’ article is to demystify central auditory disorders for neurologists, and to show that they can be assessed like any other neurological symptom, based on a consideration of the anatomy and physiology of the auditory pathway... To illustrate this we describe the case history of a patient who had lost the ability to recognise and appreciate music who presented to an audiology clinician (DMB), who then sought neurology support (TEC, TDG)... After the second incident, he pulled over and called an ambulance, as he felt ‘disorientated’... The ambulance crew found him to be confused and complaining of headache and nausea, so brought him to hospital... This coincided with a gradual improvement in speech reception threshold (the minimum volume at which a patient can understand 50% of simple consonant-vowel-consonant words)... More detailed testing of speech perception 4 years after the second event found a significantly impaired ability to distinguish minimal pairs of real words (eg, bear vs pear) but excellent performance distinguishing words from non-words (eg, bus vs mus)... The time structure of sound at the level of 10s of milliseconds is a critical feature relevant to speech and music perception... He was almost completely unable to detect frequency modulation at a rate of 40 Hz that is usually heard as a roughness (unmeasurably poor performance)... Tests of timing analysis in the 100s of milliseconds range found only mild deficits... Because it is the first point of convergence of the auditory pathway, lesions of the brainstem also commonly lead to problems with integrating the inputs of both ears for spatial sound analysis... In our patient, his profound deficit for detecting acoustic features over timescales of milliseconds or 10s of milliseconds correctly localises the lesion to the auditory nerve or brainstem nuclei... Multiple sclerosis is a common cause of brainstem lesions, and the efferent auditory pathway can be abnormal even with a normal MRI... Patients with aphasia resulting from stroke or neurodegeneration have significant difficulties with the processing of non-verbal sounds.

No MeSH data available.