Brain, Vol. 118, No. 6, 1395-1409, 1995
© 1995 Guarantors of Brain
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The functional anatomy of recovery from auditory agnosia
A PET study of sound categorization in a neurological patient and normal controls
1Departments of Neurology and ENT, RWTH Aachen Germany 2Departments of Neurology and ENT, RWTH Aachen Germany 3Welcome Department of Cognitive Neurology, Institute of Neurology University College London, UK 4MRC Cyclotron Unit, Hammersmith's Hospital University College London, UK 5Department of Psychology University College London, UK 6The New York Hospital, Cornell Medical Center New York, USA
Correspondence to:
Correspondence to: Almut Engelien, Neurolinguistics, Pauwelsstr. 30, 52057 Aachen, Germany
H215O-PET was used to investigate the functional anatomy of recovery in a patient (J.B.) with bilateral perisylvian strokes and auditory agnosia, who partially regained the ability to recognize environmental sounds, but remained clinically word-deaf. The patient and a group of siz normal volunteers were scanned in the following three conditions: (i) passive listening to environmental sounds; (ii) categorization of environmental sounds; (iii) at rest. In normal subjects, passive listening as compared with rest was associated with significant activations in the auditory cortices and posterior thalami, and in the inferior parietal lobe and anterior insulat/frontal opercular region on the right. In J.B., activations were observed in the spared auditory cortex and inferior parietal lobe of the right hemisphere and in regions adjacent to the perisylvian lesion in the left hemisphere (anterior insula/frontal opercular region, middle temporal gyrus and inferior parietal lobe). The recovered functin, as measured by categorization of sounds compared with passive listening, in J.B. was associated with bilateral activation of a distributed network comprising (pre)frontal, middle temporal and inferior parietal cortices, as well as the right cerebellum and the right caudate nucleus. In addition, there was a left-sided activation of the anterior cingulate gyrus. In normal subjects, the same categorization task led to activation of a network comprising (pre)frontal, middle temporal and inferior parietal cortices in the left hemisphere only. These results suggest that bilateral activation (with recruitment of areas homologous to those known to be responsible for normal function), the engagement of peri-infarct regions, and the involvement of a more widespreaed neocortical network, are mechanisms of functional reorganization after injury that may enable revcovery from, or compensation for, cognitive deficits
auditory agnosia; recovery; audition; cognition; PET
Received December 29, 1994. Revised May 23, 1995. Accepted July 10, 1995.
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