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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.

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Related in: MedlinePlus

Unenhanced CT of head at the time of the second infarction. The area of haemorrhage is confined to the left internal colliculus. There is some secondary hydrocephalus (not shown), indicating obstruction of the cerebral aqueduct.
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PRACTNEUROL2014001073F2: Unenhanced CT of head at the time of the second infarction. The area of haemorrhage is confined to the left internal colliculus. There is some secondary hydrocephalus (not shown), indicating obstruction of the cerebral aqueduct.

Mentions: Four years later, he was woken from sleep by a tremendously loud noise, “like a spaceship landing”. He was disorientated, vomited and complained of headache and numbness of the right arm. He attended hospital, where it quickly became clear that he was completely deaf. Neurological examination was normal except for diplopia on left gaze, and his systolic blood pressure was 156/95 mm Hg. Over the next 12 h, his Glasgow Coma Scale score fell from 15 to 8 (E1, V2, M5) and his blood pressure rose to 214/76 mm Hg. Unenhanced CT of the head showed an isolated haemorrhage of the left inferior colliculus (figure 2) with obstruction of the cerebral aqueduct and consequent hydrocephalus. An intraventricular drain was inserted. The following day, he was fully conscious and orientated and able to communicate with whiteboard and pen. By discharge on day 14, he was aware of noises occurring but could not characterise them. He had no comprehension of speech, and suffered extremely loud and troublesome bilateral tonal tinnitus.


The functional anatomy of central auditory processing.

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

Unenhanced CT of head at the time of the second infarction. The area of haemorrhage is confined to the left internal colliculus. There is some secondary hydrocephalus (not shown), indicating obstruction of the cerebral aqueduct.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

PRACTNEUROL2014001073F2: Unenhanced CT of head at the time of the second infarction. The area of haemorrhage is confined to the left internal colliculus. There is some secondary hydrocephalus (not shown), indicating obstruction of the cerebral aqueduct.
Mentions: Four years later, he was woken from sleep by a tremendously loud noise, “like a spaceship landing”. He was disorientated, vomited and complained of headache and numbness of the right arm. He attended hospital, where it quickly became clear that he was completely deaf. Neurological examination was normal except for diplopia on left gaze, and his systolic blood pressure was 156/95 mm Hg. Over the next 12 h, his Glasgow Coma Scale score fell from 15 to 8 (E1, V2, M5) and his blood pressure rose to 214/76 mm Hg. Unenhanced CT of the head showed an isolated haemorrhage of the left inferior colliculus (figure 2) with obstruction of the cerebral aqueduct and consequent hydrocephalus. An intraventricular drain was inserted. The following day, he was fully conscious and orientated and able to communicate with whiteboard and pen. By discharge on day 14, he was aware of noises occurring but could not characterise them. He had no comprehension of speech, and suffered extremely loud and troublesome bilateral tonal tinnitus.

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.


Related in: MedlinePlus