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PubMed1989

[A case of auditory agnosia with the lesion of bilateral auditory radiation].

A 53-year-old man showed central auditory disturbance with recurrent cerebral hemorrhage. At his acute stage he had deafness and auditory anosognosia. Two or three months later, there was no deafness and auditory anosognosia, but he could not comprehend words, environmental sounds and music. Auditory brainstem responses showed no peripheral or brainstem damage, and the lesion of bilateral auditory radiation was detected by MRI. His auditory agnosia did not improve over one and a half year. There is no report like such permanent auditory agnosia with the lesion of bilateral subcortical temporal lobe.

Agnosia↗
PubMed1988

[Associative visual agnosia--a case report].

A 61 year-old right-handed man, a president of a company fell downstairs and was found unconscious on January 1, 1985. He was admitted to a hospital and he had been unresponsive for 10 days. As he recovered from the consciousness disturbance, he complained of difficulties in discrimination of common objects and in recognition of familiar faces. The patient was admitted to our hospital for the closer examination on July 29, 1985. There was no abnormality in the general physical examination on admission. Neurological examinations revealed no significant deficits except visual field disturbance. In the results of WAIS, the verbal IQ was 108, but the performance IQ was unmeasurable because of a presence of object agnosia. His spontaneous speech was fluent without paraphasia, perseveration or dysprosody. His auditory comprehension of spoken language and repetition were spared. Neuropsychological examinations revealed an impairment in the recent verbal memory, alexia, agraphia, object agnosia, color naming difficulty, prosopagnosia and visuospatial constructional disability. The patient exhibited three major neuropsychological characteristics. Firstly, the recognition of the objects which were presented by the photograph or line drawing was more severely impaired than the real objects. Secondly, the object naming difficulty was more pronounced in the presentation at an unusual angle than in the free presentation. Thirdly, the patient made poor performance in reproduction of the models by photographic presentation as compared with the presentation of the real models in the three-dimensional block construction test. The CT scan performed on January 4, 1985 demonstrated subcortical hematomas with surrounding edema in the temporo-occipital regions of both hemispheres.(ABSTRACT TRUNCATED AT 250 WORDS)

Agnosia↗
PubMed1983

Mini-object test: a new brief clinical assessment for aphasia-apraxia-agnosia.

Primary degenerative dementia (Alzheimer's disease) is characterized by intellectual decline with impairment of memory, judgment, and abstract thinking. Also common are personality changes and disturbances of higher cortical function such as aphasia, apraxia, and agnosia. Standardized brief cognitive tests are useful for evaluating mental status, which is often limited by short attention span, distractibility, fatigability, mental retardation, illiteracy, and/or confusion. Data from 225 institutionalized patients support the mini-object test (MOT) as a valid, reliable, cost-effective, portable screening procedure for confirming the clinical diagnosis of aphasia-apraxia-agnosia associated with senile dementia of the Alzheimer type. Further studies are needed to demonstrate the diagnostic value of the MOT in other dementing disorders.

Aged↗
PubMed1982

[A case of pure word deafness and auditory agnosia associated with bilateral temporo-parietal lesions].

A-49-year-old right-handed female was reported. She showed pure word deafness and auditory agnosia because of bilateral temporo-parietal lesions. The left lesion resulted from angiospasm of the left anterior and middle cerebral arteries after subarachnoid hemorrhage due to a ruptured aneurysm of the left carotid artery, and the right one resulted from subcortical hematoma after the V-P shunt operation. CT scan revealed the abnormal low density area on the bilateral temporo-parietal regions seven months after onset. Neurophychological findings were as follows: there were no aphasic symptoms such as paraphasia, word finding difficulties, or disturbances of spontaneous writing, reading and calculation. But her auditory comprehension was severely disturbed, and she could neither repeat words after the tester nor write from dictation. She also could not recognize meaningful sounds and music in spite of normal hearing sensitivity for pure tone, BSR and AER. We discussed the neuropsychological mechanisms of auditory recognition, and assumed that each hemisphere might process both verbal and non-verbal auditory stimuli in the secondary auditory area. The auditory input may be recognized at the left association area, the final level of this mechanism. Pure word deafness and auditory agnosia of this case might be caused by the disruption of the right secondary auditory area, the pathway between the left primary auditory area and the left secondary auditory area, and between the left and right secondary auditory areas.

Agnosia↗
PubMed1981

[Confabulatory anomia from visual and tactile agnosia in a case of multi-infarct dementia. Neuropsychological study (author's transl)].

Observation of a patient suffering from a double softening of the brain (inner side of right temporal lobe, left occipital lobe). Clinically, Korsakoff's syndrome, right quadranopsia, pure alexia, tactile and visual agnosia concerning objects, colors and faces. Relative integrity of elementary perceptions (matching tests), impairments of stimulus identification (Lissauer's associative agnosia). Phenomena of sensoriphasic interactions are reported: normal speech in conversation, contrasting with confabulant anomia when naming or describing visual or tactile stimuli: then, escaping the control of sight, a relative "autonomy" of speech appears, with word perseverations and semantic "slipping" and filiations. Discussion of optical aphasia.

Agnosia↗
PubMed1995

[Familial posterior cortical atrophy with visual agnosia and Bálint's syndrome].

We report a patient of posterior cortical atrophy with progressive visual agnosia, Bálint's syndrome and dementia in which posterior cortical atrophy with similar characteristics on CT and progressive dementia were found in a sister. The patient was a 75-year-old woman who noted the onset of a progressive visual disorder at the age of 70, and whose family first noticed disoriented behavior at around the same period. Ophthalmologic examinations revealed mild cataract but no evidence of peripheral optic nerve or retinal lesions. Neuropsychological examination showed right homonymous hemianopia, visual agnosia, Bálint's syndrome, mild transcortical sensory aphasia, Gerstmann's syndrome, constructional apraxia, mild ideomotor apraxia and memory disorder. MRI showed marked dilatation of both lateral ventricles, especially the posterior horns, and severe atrophy of the occipital lobes, hippocampus, and the parahippocampal gyrus. Assessment of regional cerebral blood flow by IMP-SPECT revealed a generalized decrease in the temporo-parieto-occipital region bilaterally. The patient's sister began to show evidence of progressive dementia at 80 years of age and CT of the brain revealed marked atrophy, predominantly in the occipital lobes, similar to that of the patient. We believe this to be the first report of posterior cortical atrophy with a positive family history, suggesting the possibility of a hereditary syndrome.

Aged↗
PubMedDate not supplied

[Verbal auditory agnosia: SPECT study of the brain].

Verbal auditory agnosia are rare in clinical practice. Clinically, it characterized by impairment of comprehension and repetition of speech but reading, writing, and spontaneous speech are preserved. So it is distinguished from generalized auditory agnosia by the preserved ability to recognize non verbal sounds. We present the clinical picture of a forty-years-old, right handed woman who developed verbal auditory agnosic after an bilateral temporal ischemic infarcts due to atrial fibrillation by dilated cardiomyopathie. Neurophysiological studies by pure tone threshold audiometry: brainstem auditory evoked potentials and cortical auditory evoked potentials showed sparing of peripheral hearing and intact auditory pathway in brainstem but impaired cortical responses. Cranial CT-SCAN revealed two large hypodenses area involving both cortico-subcortical temporal lobes. Cerebral SPECT using 99mTc-HMPAO as radiotracer showed hypoperfusion just posterior in both frontal lobes nect to Roland's fissure and at level of bitemporal lobes just anterior to Sylvian's fissure.

Adult↗
PubMed1997

["Associative" visual agnosia for objects, pictures, faces and letters with altitudinal hemianopia].

We report a 63-year-old right-handed man with the associative visual agnosia and bilateral altitudinal hemianopia. Neurological examination revealed fair visual acuity and normal ocular movement. Other cranial-nerve, motor, sensory, and autonomic functions were normal. The brain MRI showed multiple infarction involving the right fusiform and lingual gyri extending to the adjacent white matter of the occipito-temporal lobes and posterior part of the parahippocampus, the left fusiform and lingual gyri, and multiple lacunae in bilateral basal ganglia. Cerebral angiography demonstrated occlusion at the P1 portions of bilateral posterior cerebral arteries. 123I IMP-SPECT revealed decreased perfusion in bilateral occipital lobes, worse on the right. Visual evoked fields showed normal pattern of P100 m on bilateral occipital lobes. Neuropsychologically he was alert and oriented in place. In WAIS-R, he could not perform any of performance subtests, while his VIQ was 72. His verbal and visual memory was impaired. His visual perception of forms seemed to be almost preserved. He could copy simple drawing precisely, although he could not recognize the drawing just copied. He could match pictures, letters and photographs of faces. His visual identification of forms, on the other hand, was severely disturbed. He could identify only simple geometrical figures, but not simple drawings such as an apple or the face of his daughter. Reading Kanji was impaired and he read Kana in letter-by-letter manner. Tactile identification of objects was much better than visual one. Naming objects from verbal description was well preserved. Drawing fruits or cars from memory was intact. These data suggests that the present case had fairly good visual perception as was demonstrated by good copying and matching performance, and the case could be classified into the associative type of visual agnosia if the dichotomized classification of apperceptive and associative type is employed. However, closer look at his way of copying clearly showed that he copied in piecemeal fashion, suggesting difficulty in seeing a figure as a dynamic whole. It is possible that fine and precise discrimination of shape and pattern is subserved by the bilateral ventral or occipito-temporal visual system which was compromized in the present case.

Agnosia↗
PubMed1998

Persistent recurrence of hypomania and prosopoaffective agnosia in a patient with right thalamic infarct.

The authors report a 63-year-old man with a history of brief isolated manic episodes who became persistently hypomanic after a small right thalamic infarct. Detailed behavioral and neuropsychologic assessment were performed 18 months after the stroke and revealed a prosopoaffective agnosia as the foremost cognitive disorder, i.e., an impairment in the identification of emotional facial expressions with preserved discrimination of facial identity. Difficulties in reasoning on humorous material and other signs of mild right hemisphere dysfunction were present, but other perceptual, frontal and abstract-reasoning cognitive functions were unimpaired. Prosopoaffective agnosia has not been reported previously in thalamic lesions or in primary or secondary mania. The authors discuss the hypothetical relationships between a right hemisphere deficit in processing emotions and relapsing of the patient's hypomanic behavior.

Affective Symptoms↗
PubMed1978

Clinical and anatomic findings in a case of auditory agnosia.

A case is reported of severe agnosia for verbal and nonverbal sounds in a setting of well-preserved intelligence and transient dysphasic symptoms. The lesions responsible for this disorder were bilateral cerebral infarcts, one of which had virtually destroyed the areas of Wernicke and Broca. The relation between lesions and disabilities is discussed and comparisons made with other published cases.

Aged↗
PubMed1986

Loss of topographic familiarity. An environmental agnosia.

Sixteen patients manifested the syndrome of loss of environmental familiarity. The syndrome is characterized by an inability to recognize familiar surroundings in spite of relatively intact verbal memory, cognition, and perception. In addition to the loss of environmental familiarity, other clinical disturbances, including central achromatopsia, prosopagnosia, palinopsia, visual hallucinations, dressing disturbances, or impaired revisualization, were present in several cases. Radiologic studies revealed that all patients had right medial temporo-occipital lesions; three had additional left-sided lesions. Clinical observations suggest that the syndrome is a class-specific agnosia similar to prosopagnosia.

Adult↗
PubMed1993

Diazepam therapy of verbal auditory agnosia.

A 7-year-old girl suffered from a gradual loss of her ability to understand speech. But she had normal hearing and understood various environmental sounds. Brain computerized axial tomography showed normal, but electroencephalogram revealed spike and wave activity from temporal leads, especially on the left side. She was diagnosed as having verbal auditory agnosia. The treatment consisted of diazepam therapy. One year after the onset, her impaired auditory comprehension dramatically improved with the use of diazepam. The dichotic listening test revealed a left ear advantage for both environmental sounds and spoken words. The results seemed to suggest that in this patient the right hemisphere might be functioning as a speech center instead of the left one.

Agnosia↗
PubMed1995

Electrophysiologic manifestations of impaired temporal lobe auditory processing in verbal auditory agnosia.

The present study examined the extent to which verbal auditory agnosia (VAA) is primarily a phonemic decoding disorder, as contrasted to a more global defect in acoustic processing. Subjects were six young adults who presented with VAA in childhood and who, at the time of testing, showed varying degrees of residual auditory discrimination impairment. They were compared to a group of young adults with normal language development matched for age and gender. Cortical event-related potentials (ERPs) were recorded to tones and to consonant-vowel stimuli presented in an "oddball" discrimination paradigm. In addition to cortical ERPs, auditory brainstem responses (ABRs) and middle latency responses (MLRs) were recorded. Cognitive and language assessments were obtained for the VAA subjects. ABRs and MLRs were normal. In comparison with the control group, the cortical ERPs of the VAA subjects showed a delay in the N1 component recorded over lateral temporal cortex both to tones and to speech sounds, despite an N1 of normal latency overlying the frontocentral region of the scalp. These electrophysiologic findings indicate a slowing of processing of both speech and nonspeech auditory stimuli and suggest that the locus of this abnormality is within the secondary auditory cortex in the lateral surface of the temporal lobes.

Adolescent↗
PubMed1998

Chronic auditory agnosia following Landau-Kleffner syndrome: a 23 year outcome study.

We report a 27-year-old woman with chronic auditory agnosia following Landau-Kleffner Syndrome (LKS) diagnosed at age 4 1/2. She grew up in the hearing/speaking community with some exposure to manually coded English and American Sign Language (ASL). Manually coded (signed) English is her preferred mode of communication. Comprehension and production of spoken language remain severely compromised. Disruptions in auditory processing can be observed in tests of pitch and duration, suggesting that her disorder is not specific to language. Linguistic analysis of signed, spoken, and written English indicates her language system is intact but compromised because of impoverished input during the critical period for acquisition of spoken phonology. Specifically, although her sign language phonology is intact, spoken language phonology is markedly impaired. We argue that deprivation of auditory input during a period critical for the development of a phonological grammar and auditory-verbal short-term memory has limited her lexical and syntactic development in specific ways.

Adult↗
PubMed2000

Perception of dynamic acoustic patterns by an individual with unilateral verbal auditory agnosia.

Previous studies have found that subjects diagnosed with verbal auditory agnosia (VAA) from bilateral brain lesions may experience difficulties at the prephonemic level of acoustic processing. In this case study, we administered a series of speech and nonspeech discrimination tests to an individual with unilateral VAA as a result of left-temporal-lobe damage. The results indicated that the subject's ability to perceive steady-state acoustic stimuli was relatively intact but his ability to perceive dynamic stimuli was drastically reduced. We conclude that this particular aspect of acoustic processing may be a major contributing factor that disables speech perception in subjects with unilateral VAA.

Adult↗
PubMed2002

Grasping two-dimensional images and three-dimensional objects in visual-form agnosia.

Visually guided prehension is controlled by a specialized visuomotor system in the posterior parietal cortex. It is not clear how this system responds to visual stimuli that lack three-dimensional (3D) structure, such as two-dimensional (2D) images of objects. We asked a neurological patient with visual-form agnosia (patient D.F.) to grasp 3D objects and 2D images of the same objects and to estimate their sizes manually. D.F.'s grip aperture was scaled to the sizes of the 2D and 3D target stimuli, but her manual estimates were poorly correlated with object size. Control participants demonstrated appropriate size-scaling in both the grasping and manual size-estimation tasks, but tended to use a smaller peak aperture when reaching to grasp 2D images. We conclude that: (1) the dorsal stream grasping system does not discriminate in a fundamental way between 2D and 3D objects, and (2) neurologically normal participants might adopt a different visuomotor strategy for target objects that are recognized to be ungraspable. These findings are consistent with the view that the dorsal grasping system accesses a pragmatic, spatial representation of the target object, whereas the ventral system accesses a more comprehensive, volumetric description of the object.

Adult↗
PubMed2001

The role of size and binocular information in guiding reaching: insights from virtual reality and visual form agnosia III (of III).

Reaching out to grasp an object requires information about the size of the object and the distance between the object and the body. We used a virtual reality system with a control population and a patient with visual form agnosia (DF) in order to explore the use of binocular information and size cues in prehension. The experiments consisted of a perceptual matching task in addition to a prehension task. In the prehension task, control participants modified their reach distance in response to step changes in vergence in the absence of any clear reference for relative disparity. Their reach distance was unaffected by equivalent step changes in size, even though they used this information to modify grasp and showed a size bias in a distance matching task. Notably, DF showed the same pattern of results as the controls but was far more sensitive to step changes in vergence. This finding complements previous research suggesting that DF relies predominantly on vergence information when gauging target distance. The results from the perceptual matching tasks confirmed previous findings suggesting that DF is unable to make use of size information for perceptual matching, including distance comparisons. These data are discussed with regard to the properties of the pathways subserving the two visual cortical processing streams.

Agnosia↗
PubMed2001

Vertical gaze angle as a distance cue for programming reaching: insights from visual form agnosia II (of III).

It has been shown that a patient with visual form agnosia (DF) relies predominantly on vergence information when gauging target distance in an open-loop pointing task. This finding suggested that the programming of prehension might be severely disrupted if DF viewed target objects through ophthalmic prisms. An initial experiment showed that this prediction was not upheld; DF was able to programme reasonably accurate movements to objects located on a tabletop despite large changes in vergence angle. A second experiment, however, showed that placing the target objects at eye height whilst manipulating vergence angle caused gross disruption to prehension, with DF mis-programming the reach component in a predictable manner. Notably, the evidence for DF's reliance on vergence distance information was obtained in a task where the targets were viewed at eye height. These experiments indicate that DF uses vertical gaze angle to gauge target distance in normal prehension and suggest that this extra-retinal cue may be a useful source of distance information for the human nervous system, especially where pictorial cues are impoverished.

Agnosia↗