Brain, Vol. 123, No. 3, 532-545,
March 2000
© 2000 Oxford University Press
Invited review |
The neural correlates of `deaf-hearing' in man
Conscious sensory awareness enabled by attentional modulation
1 Technical University of Aachen, Aachen, Germany, 2 Wellcome Department of Cognitive Neurology, London, UK and 3 Functional Neuroimaging Laboratory, Department of Psychiatry, The New York Hospital-Cornell Medical Center, New York, USA
Correspondence to:
Almut Engelien, MD, Functional Neuroimaging Laboratory, Cornell University Medical College, 525 E. 68th Street, Box 140, New York, NY 10021, USA E-mail: almut{at}hanazono.med.cornell.edu
Attentional modulation of normal sensory processing has a two-fold impact on human brain activity: activation of a network of localized brain regions is associated with paying attention, and activation of specific sensory regions is enhanced relative to passive stimulation. The mechanisms underlying attentional modulation of perception in patients with lesions of sensory cortices are less well understood. Here we report a unique patient suffering from extensive bilateral destruction of the auditory cortices (including the primary auditory fields) who demonstrated conscious perception of the onset and offset of sounds only when selectively attending to the auditory modality. This is the first description of such an attentively modulated `deaf-hearing' phenomenon and its neural correlates, using H215O-PET. Increases in cerebral blood flow associated with conscious awareness of sound that was achieved by listening attentively (compared with identical auditory stimulation presented when the patient was inattentive) were found bilaterally in the lateral (pre)frontal cortices, the spared middle temporal cortices and the cerebellar hemispheres. We conclude that conscious awareness of sounds may be achieved in the absence of the primary auditory cortex, and that selective, `top-down' attention, associated with prefrontal systems, exerts a crucial modulatory effect on auditory perception within the remaining auditory system.
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