GENERALIZED AUDITORY AGNOSIA WITH SPARED
MUSIC RECOGNITION IN A LEFT-HANDER.
ANALYSIS OF A CASE WITH A RIGHT TEMPORAL
STROKE
Mario F. Mendez
(Departments of Neurology and Psychiatry, University of California at Los Angeles)

ABSTRACT
After a right temporoparietal stroke, a left-handed man lost the ability to understand
speech and environmental sounds but developed greater appreciation for music. The patient
had preserved reading and writing but poor verbal comprehension. Slower speech, single
syllable words, and minimal written cues greatly facilitated his verbal comprehension. On
identifying environmental sounds, he made predominant acoustic errors. Although he failed
to name melodies, he could match, describe, and sing them. The patient had normal hearing
except for presbyacusis, right-ear dominance for phonemes, and normal discrimination of
basic psychoacoustic features and rhythm. Further testing disclosed difficulty distinguishing
tone sequences and discriminating two clicks and short-versus-long tones, particularly in
the left ear. Together, these findings suggest impairment in a direct route for temporal
analysis and auditory word forms in his right hemisphere to Wernicke’s area in his left
hemisphere. The findings further suggest a separate and possibly rhythm-based mechanism
for music recognition.
Key words: auditory agnosia, cortical auditory disorders, amusia, word deafness

INTRODUCTION
Generalized auditory agnosia, or cortical auditory disorder, is a rare condition
usually associated with bilateral temporal lesions (Bauer, 1997). Auditory
agnosia refers to an impaired capacity to recognize sounds in the presence of
otherwise adequate hearing as measured by standard audiometry. The term has
been used broadly to refer to impaired capacity to recognize sounds in general
(generalized auditory agnosia) and, in a narrower sense, to a selective deficit in
recognizing nonverbal sounds only (selective auditory agnosia).
In addition to generalized auditory agnosia, specific lesions can produce
other “cortical auditory deficits.” Selective auditory agnosia for meaningful
sounds may result from lesions in the right hemisphere, especially the
temporoparietal area (Fujii, Fakatsu, Watabe et al., 1990; Nielsen and Sult,
1939; Spreen, Benton and Fincham, 1965; Wortis and Pfeffer, 1948). Isolated
verbal agnosia or pure word deafness (PWD) may result from bilateral or from
isolated left temporal lesions that presumably disconnect Wernicke’s area
(Coslett, Brashear and Heilman, 1984; Shoumaker, Ajax and Schenkenberg,
1977). Patients with PWD cannot understand spoken language but they can read,
copy and write spontaneously, and speak in a relatively normal manner
Cortex, (2001) 37, 139-150

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(Buchman, Garron, Trost-Cardamone et al., 1986). Isolated receptive amusia, or
the loss of musical ability or appreciation, can follow right, left, or bilateral
temporal strokes (Griffiths, Rees, Witton et al., 1997; Mavlov, 1980; Sparr,
1999). These different auditory syndromes imply that lesions in the left temporal
region are necessary for agnosia for verbal sounds, lesions in the right temporal
region are necessary for agnosia for non-verbal sounds, and either left or rightsided lesions may result in various disturbances in musical ability.
This paper presents a left-handed patient whose cortical auditory syndrome
deviated from these patterns in several respects. He is unique because of the
presence of both verbal and non-verbal auditory agnosia from a stroke involving
the right temporal region, along with an increased interest and appreciation of
music. The aim of this study was to clarify the underlying mechanism for his
unusual combination of neurological auditory manifestations.
CASE REPORT
NS, a 68-year-old left-handed man, had difficulty understanding speech after a stroke
sustained during coronary artery bypass surgery. When he awoke from anesthesia, he could
not understand what people were saying, as if they were “speaking too fast or in Chinese.”
His own speech was not affected, and he could read and write. In addition, environmental
sounds became indistinct and difficult to understand. The initial evaluation did not reveal
focal abnormalities on his neurological examination, and his neuroimaging disclosed a right
temporoparietal stroke.
Over the course of the next twelve years, the patient continued with difficulty
comprehending speech and environmental sounds. His wife reported that people resorted to
writing notes to him because he could not follow oral conversations. In general,
communication was achieved through writing. In this way, NS was able to maintain his
lifestyle, including reading multiple newspapers, following the stock market, and
maintaining his finances. He gravitated to reading and to “listening” with closed captions to
television programs. Moreover, his appreciation of music increased over the years. Previous
to his stroke, he had not shown a prominent interest in music. After his stroke, he spend
much of his day listening to music. NS and his wife became avid attendees at concerts and
other musical performances.
Twelve years after his stroke, the patient underwent further evaluation for his auditory
disorder. On interview, he was aware of his auditory difficulty and reported that speech
still sounded fast and foreign and environmental sounds muffled. He endorsed a greater
appreciation of music and would illustrate this by breaking out into song. The patient was a
retired accountant who did not smoke and only occasionally used alcohol. He was strongly
left-handed all of his life and was “left-footed” in sports. His past medical history was
significant for coronary artery disease and benign prostatic hypertrophy, and his family
history was negative for known familial illnesses and positive for left-handedness.
On examination, this older man appeared much younger than his age. He was alert,
attentive, and well oriented to place and time. NS was very talkative and had a slightly
empty but otherwise fluent output without paraphasic errors. When spoken to, however, he
appeared confused and perplexed. He could not comprehend most simple, verbal, one-step
commands or yes/no questions but had no difficulty comprehending written commands. For
example, he could not understand the verbal command “touch your chin” but immediately
understood it in writing, and when asked “are we in New York?” he replied “Yes, I was
born in New York.” Access to lip reading, careful attention to facial expression, and slowing
of speech helped his auditory comprehension and allowed him to follow many simple
commands. He attempted to visualize spoken words by spelling the words aloud or with his
hands. Seeing a spoken word simultaneously written resulted in instantaneous auditory
recognition with an expression of sudden discovery. The Token Test confirmed verbal, but

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TABLE I

Neuropsychological Tests (Administered with Written Instructions)
Mini-Mental State Examination (without the 3-word registration):
24/27
Missed one item on counting backwards by 7’s, one memory item, and the repetition item
CERAD* Auditory Verbal Learning Task (10 written words)
(approx. within normal limits)
Immediate trials: A: 3, B: 6: C: 8
Fifteen minute spontaneous delayed recall: 6/10 and Recognition: 20/20
Rey-Osterieth Complex Figure
Copy 33/36
(30.14 ± 5.6)**
3 minute delayed recall: 9 (percent recall: 27%)
(8.41 ± 5.9)
Trailmaking A: 52”
(44th percentile; 0 errors)
Raven’s Coloured Progressive Matrices 29/36 A: 10, Ab: 10, B: 9
(95th percentile)
Language Tests
Verbal Fluency (FAS)
17
(39.08 + 14.17; cut-off 11)
Boston Naming Test (BNT)
28/60
(51.56 + 7.0; cut-off 37)
h BNT word comprehension (written word-picture match; 4 item multiple choice): 58/60
Original Token Test
(very abnormal performance)
Part I:
Oral
5
Stretched
9
Written
10
Part II:
Oral
3
Stretched
6
Written
10
Part III:
Oral
0
Stretched
1
Written
10
Part IV:
___________
_________________
Written
10
Part V:
___________
_________________
Written
22
*Consortium to Establish a Registry in Alzheimer’s Disease; Reference tests to Lezak, 1995, and Mutrishina et al.,
1999. **Norms and standard deviations.

not written, comprehension difficulty with improvement when speech was slowed or
“stretched” (Boller and Vignolo, 1966; De Renzi and Vignolo, 1962) (See Table I).
Additional language testing was done. On confrontational naming, NS had difficulty
producing names on the Boston Naming Test (BNT) (Kaplan, Goodglass and Weintraub,
1978) (see Table I). Because he could not take spoken cues, word comprehension was
tested using written words. He was able to correctly match nearly all of the words with one

a

b

Fig. 1 – Magnetic resonance imaging (MRI) disclosed a large area of infarction in the right
temporoparietal region. a: T1-weighted horizontal image showing the wedge-shaped infarction. b: T1weighted sagittal view of the right hemisphere showing extension of the infarction along the superior
temporal gyrus, Wernicke’s area, and Heschl’s gyrus, and extending posteriorly. The study was done
12 years after his stroke.

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Fig. 2 – Functional neuroimaging with 18-fluorodeoxyglucose positron emission tomography
(PET) showed focal right temporal lobe hypometabolism. No other areas of hypometabolism were
present. PET imaging was performed in a resting state. The study was done 12 years after his stroke.

of four BNT pictures. Reading and writing were normal, and he could repeat single words
perfectly. NS had trouble repeating longer phrases. For example, his attempt at repeating
“no ifs ands or buts” was “nose hits blands and the bluffs,” and his attempt at repeating
“for whom the bell tolls” was “for whom the spell extols.” His speech inflection and
prosody were intact, and he responded to prosody. Finally, NS performed adequately on
other neuropsychological tests (Mutrishina, Boone and D’Elia, 1999), although testing was
limited because of his pronounced auditory comprehension deficit (see Table I).
His general physical and neurological examinations were normal, but neuroimaging
confirmed his single right hemisphere stroke. His cranial nerves were intact including clinical
screening for hearing impairment. Visual fields were intact and there was no evidence of
hemispatial neglect. Coordination, gait, motor, and sensory examinations did not reveal
abnormalities. His reflexes were 2+ and symmetrical, and toes were downgoing. No
pathologic reflexes were present. The patient had magnetic resonance imaging (MRI) which
showed a single, large infarct of the right temporal lobe extending into the parietal region (see
Figure 1). Functional neuroimaging with 18-fluorodeoxyglucose positron emission
tomography (PET) showed focal right temporal lobe hypometabolism only (see Figure 2).
After this evaluation, NS’s course included continued speech therapy with supported
conversation. The goal was to improve the quality of his communication with his wife. He
also agreed to undergo further audiological and psychoacoustic testing.

NEUROLOGICAL INVESTIGATION
Audiological and Dichotic Testing
On pure tone audiometry, he had presbyacusis with normal hearing in the
speech range (see Figure 3). With his eyes closed, NS was able to point to
different sound sources (voices, clapping, bells) in the testing room. Finally, the

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Fig. 3 – Pure tone threshold audiogram. X = left ear, 0 = right ear, HL = hearing level. Hearing
levels are in dB (ANSI, 1969). There is high frequency hearing compatible with presbyacusis.

patient had an assessment of click-fusion threshold by the method of ascending
and descending limits, as previously described (Albert and Bear, 1974;
Motomura, Yamadori, Mori et al., 1986). Two clicks of 0.1 msec in duration
were presented binaurally and monaurally at different intervals. NS reported
whether he heard a single click or two clicks. The patient fused these clicks at
mean intervals of 16 msec in both ears, 8 msec in the right ear and 92 ms in the
left. Prior reports note that normals can distinguish two clicks at 1-3 msec
separation (Albert and Bear, 1974; Motomura et al., 1986).
Dichotic listening was performed using the VA-CD Tonal and Speech
Materials of Auditory Assessment (Nofsinger, Martinez and Wilson, 1994). The
initial dichotic test consisted of 30 presentations of different nonsense syllables
simultaneously played in each ear after adjusting for volume at about 50-60 db.
The patient’s potential responses included 6 possible choices: the right ear
phoneme, the left ear phoneme, and four random choices. On this dichotic
listening test, he lateralized 20 presentations in the right ear, 3 to the left ear,
and 7 were random, demonstrating a right ear advantage for these phonemes. A
second dichotic test evaluated the discrimination of tones (1000 Hz) of short
duration (250 ms) versus long duration (500 ms) from either ear, masked by

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tones of varying frequencies in the opposite ear. On this test, he was
administered 60 trials of three tones varying in long and short tone sequences
(ISI 200 msec). NS had difficulty in both ears, particularly the left: correct
responses were 33 in the right ear and 18 in the left ear.
Psychoacoustic Test Methods
The Speech Sounds Perception Test and the Seashore Rhythm Test are wellknown standardized tests (Lezak, 1995; Mutrishina et al., 1999). Most of the
other psychoacoustic tasks were previously described (Mendez and Geehan,
1988) and include pilot control data demonstrating 100% correct responses on
these measures. The testing sessions were limited to 60 minutes, and instructions
were given in writing. All auditory stimuli were presented binaurally by
loudspeakers located 2 feet from the patient. The patient was asked to:
(1) Listen to 48 pre-recorded environmental sounds and point to the
corresponding picture. Four pictures were presented with each environmental
sound. The four choices were either correct, acoustically related, semantically
related, or unrelated.
(2) Discriminate two environmental sounds as same or different by pointing
to one of two response cards marked SAME or DIFFERENT. There were 10
trials.
(3) Listen to 48 pre-recorded words and point to the corresponding picture.
Four pictures were presented with each spoken word. The four choices were
either correct, phonologically related, semantically related, or unrelated.
(4) Listen to 48 pre-recorded words and point to the corresponding written
word. Four written words were presented with each spoken word. The four
choices were either correct, phonologically related, semantically related, or
unrelated.
(5) Read 48 words and point to the corresponding picture. Four pictures were
presented with written word. The four choices were either correct,
phonologically related, semantically related, or unrelated.
(6) The Speech Sounds Perception Test. The test is composed of 60 spoken
single-syllable nonsense words all containing the long “e” vowel sound and
differing in beginning and ending consonants. There are four multiple choice
options.
(7) Listen to 10 common melodies (30 sec. samples) and point to the
corresponding picture. Four pictures depicting descriptive scenes (e.g., New
Year’s eve celebration with “Auld Lang Syne,” birthday party with “Happy
Birthday,” American revolutionary theme with “Yankee Doodle,” Christmas
carolers with “Silent Night”).
(8) Discriminate as same or different between 10 pairs of melodies.
(9) Listen to 10 common melodies (30 sec. samples) and point to the
corresponding written name. Four names were presented for each melody.
(10) The Seashore Rhythm Test. The test is composed of sequences of 5, 6,
and 7 tones set in patterns in different time. The source is a beat-frequency
oscillator set at 500 cycles. The subject was to indicate same or different.
(11) Discriminate pre-recorded pure tones as same or different with respect

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to differences in frequency, intensity, or duration. The same response cards were
used, and there were 10 trials on each task. Parameters, when not an
independent variable, were held at 60 dB, 1000 Hz, and 250 ms. Frequencies
ranged from 250 to 3000 Hz with a minimum difference of 1000 Hz, intensity
test used 70 to 90 dB with a minimum difference of 10 dB, and duration test
used 75 to 300 ms with a minimum difference of 150 ms.
(12) Discriminate as same or different between pairs comprised of three pure
tone which varied either in regularity, in frequency pattern, or in number of
tones. In the first 10 trials, three sounds varied in interstimulus intervals of
50-300 ms. In the second 10 trials, three tones varied in frequency patterns. In
the third set, they were composed of longer tone sequences of 4-6 tones.
Psychoacoustic Test Results
Table II summarizes the results of the psychoacoustic tests. Additional
observations include the following:
(1) Matching environmental sounds-pictures: Of the 21 error responses, 16
were acoustically-related (76%), three were semantically-related (14%), and two
were indeterminant (10%) (see Table III). NS focused on the rhythmic aspects of
the sounds, and often attempted to repeat the beat of the sounds.
(3) Matching of verbal words-pictures: Of the 20 error responses, 4 were
phonologically-related (20%), 4 were semantically-related (20%), and 12 were
indeterminate (60%). He identified short, single syllable words better than
longer, multisyllable words. Otherwise, his responses appeared to be random
guesses with a tendency to respond to whatever picture was located in the top
right hand corner.
TABLE II

Psychoacoustic Test Results
Test

Correct results

*1. Matching environmental sounds-pictures
2. Discrimination between two environmental sounds
*3. Matching of verbal words-pictures
4. Matching of verbal words-written words
5. Matching of written words-pictures
*6. Speech Sounds Perception Test
7. Matching of melodies-pictures
8. Discrimination between two melodies
*9. Matching of melodies-written names
10. The Seashore Rhythm Test
11. Discrimination of pure tones
based on frequency
based on intensity
based on duration
*12. Discrimination between different tone sequences
three tones with varied interstimulus intervals
three tones with varied frequency patterns
increased number of tones to 4-6

27/48 sounds
10/10 trials
28/48 spoken words
46/48 spoken words
48/48 written words
43/60**
10/10
10/10 trials
5/10 common melodies
24/30***

*NS had an impaired performance on these tests.
** Significantly less than most age-matched normals (Mutrishina et al., 1999).
***Age-adjusted normal mean 24.6 + 3.1; Bak and Greene, 1980.

10/10 trials
10/10 trials
10/10 trials
9/10 trials
8/10 trials
4/10 trials

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Mario F. Mendez
TABLE III

Environmental Sound Errors
Acoustic errors

Baby crying
Duck quacking
Hand bell
Clapping
Typing
Jack hammer
Car
Choir
Harmonica
Electric shaver
Hammering
Drain
Coarse laughter
Fire engine
Waterfall
Toilet

for
for
for
for
for
for
for
for
for
for
for
for
for
for
for
for

Cat meowing
Baby crying
Telephone
Horse galloping
Clapping
Sheep baaing
Airplane
Children’s playground
Electric shaver
Man humming
Boy running
Boy slurping
Man sawing
Church bells
Toilet
Dishes breaking

Semantic errors

Singing
Alarm clock
Man snoring

for
for
for

Orchestra
Man snoring
Man sneezing

Indeterminate errors

Parade
Airplane

for
for

Cow mooing
Cash register

(4) Matching of verbal words-written words: The presence of even the first
few letters of the written word resulted in recognition.
(6) Speech Sounds Perception Test: The patient’s errors were 61% on the
ending syllable and 39% on the beginning syllable.
(7) Matching of melodies-written names: Despite inability to name half of
the common melodies, NS could sing all of them and would do so
spontaneously. Singing the name helped recognition. Examples of errors
including mistaking “Jingle Bells” for “Auld Lang Syne,” “Happy Birthday” for
“Silent Night,” and “London Bridge” for “Yankee Doodle.” Despite these errors
in naming the tunes, he could describe their usual context, e.g., “Happy
Birthday” to celebrate someone’s anniversary.
(10) The Seashore Rhythm Test: He would hum the rhythms to himself and
would tap the rhythms out on the table.
DISCUSSION
This patient illustrated impaired auditory comprehension for both words and
sounds consequent to a stroke involving the right temporal auditory cortex.
Whereas right temporal lesions can produce non-linguistic auditory agnosia, the
presence of additional agnosia for spoken language may be due to a dependency
on alternative auditory-language pathways in this left-handed person. In addition,
NS had an increase in his appreciation of music, so much so that listening to
music became his main activity.
Generalized auditory agnosia usually results from bilateral lesions affecting
posterior temporal lobes (Godefroy, Leys, Furby et al., 1995; Ho, Kileny,
Paccioretti et al., 1987; Oppenheimer and Newcombe, 1978), subcortical

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temporal radiations (Hasegawa, Bando, Iwata et al., 1989; Kazui, Naritomi,
Sawada et al., 1990; Motomura et al., 1986), inferior colliculi (Johkura,
Matsumoto, Hasegawa et al., 1998), and even the insulae (Habib, Daquin,
Milandre et al., 1995). Prior PET studies have shown in these patients bilateral
temporal changes, albeit with a particular role for the right temporal region
(Engelien, Silbersweig, Stern et al., 1995; Nove-Josserand, Fischer,
Nighoghossian et al., 1998). In contrast, all prior cases of auditory agnosia from
isolated right-sided lesions have been selective for environmental sounds (Fujii
et al., 1990; Lambert, Eustache, Lechevalier et al., 1989; Nielsen and Sult, 1939;
Spreen et al., 1965; Wortis and Pfeffer, 1948). This is the first patient report of
generalized auditory agnosia from a right temporal lesion.
Investigators have long proposed two basic mechanisms for the agnosias, an
apperceptive (perceptual) one and an associative (semantic) one (Vignolo, 1982).
Apperceptive agnosia is impaired recognition from an abnormal percept despite
adequate sensory abilities, and associative agnosia is impaired recognition when
a normal percept does not arouse meaningful attributes. Although this dichotomy
is often indistinct (De Renzi and Lucchelli, 1993), particularly in the auditory
modality (Fujii et al., 1990; Spreen et al., 1965), many patients with right
temporal lesions have apperceptive features, and those with left-sided lesions
have associative ones. Right hemisphere patients tend to make acoustic errors in
environmental sounds, and left-hemisphere patients tend to make semantic errors
(Schnider, Benson, Alexander et al., 1994; Vignolo, 1982). In environmental
sound recognition, NS had predominant acoustic errors consistent with an
apperceptive deficit (Buchtel and Stewart, 1989; Ulrich, 1977).
The specific apperceptive deficit in generalized auditory agnosia may be a
disorder of auditory temporal processing (Buchtel and Stewart, 1989; Godefroy
et al., 1995; Kaga, Shindo and Tanaka, 1997). The literature reports
abnormalities in temporal duration (Rosati, DeBastiani, Paolino et al., 1982),
temporal resolution and summation (Albert and Bear, 1974; Auerbach, Allard,
Naeser et al., 1982; Motomura et al., 1986; Tanaka, Yamadori and Mori, 1987),
separation of two tones and click-fusion discrimination (Albert and Bear, 1974;
Buchtel and Stewart, 1989; Motomura et al., 1986; Chocholle, Chedru, Botte et
al. 1975; Kazui et al., 1990), and temporal order and sequencing (Jerger,
Weikers, Sharbrough et al., 1969; Mendez and Geehan, 1988). Difficulty in
processing brief sounds may impair connected speech and the comprehension of
prolonged series of sounds (Buchman et al., 1986; Buchtel and Stewart, 1989;
Chocholle et al., 1975). The overall pattern of audiological, dichotic, and
psychoacoustic findings in NS points to abnormal temporal processing from his
right temporal lesion.
This patient’s impaired verbal comprehension resembled PWD in having
preserved reading comprehension and a sensation of speech as fast and foreign
(Albert and Bear, 1974). In PWD, bilateral lesions of the anterior part of the
superior temporal gyri or unilateral subcortical lesions of the left temporal lobe
disconnect cortical auditory areas from a relatively intact Wernicke’s area
(Auerbach et al., 1982; Buchman et al., 1986; Coslett et al., 1984; Kanter, Day,
Heilman et al., 1986). NS’s preserved reading ability and lateralization of
phonemes to the right ear suggested a functioning Wernicke’s area in the left

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hemisphere disconnected from auditory input from his damaged right temporal
region. The processing of verbal sounds may require fine temporal
discrimination (Blumstein and Cooper, 1974), and most studies of PWD patients
show abnormalities in temporal resolution or related processes (Albert and Bear,
1974; Auerbach et al., 1982; Buchman et al., 1986; Chocholle et al., 1975;
Jerger et al., 1969; Kanshepolsky, Kelley and Waggener, 1973; Klein,
Kurtzberg, Brattson et al., 1995; Mendez and Geehan, 1988; Praamstra, Hagoort,
Maassen et al., 1991). In NS, a left-handed man, the fine temporal analysis of
verbal sounds may take place in his right auditory cortex rather than his left
Heschl’s gyrus, as is usually the case (Breitling, Guenther and Rondot, 1987;
Gates and Bradshaw, 1973; Halperin, Nachshon and Carmon, 1973).
This patient also had a unique preservation of musical appreciation. Brain
lesions can affect separate attributes of music in isolation (Polster and Rose,
1998; Peretz, Belleville and Fontaine, 1997). Bilateral temporal or isolated rightsided lesions can cause amelodia with abnormal sequencing of melodic
variations and preserved rhythm (Griffiths et al., 1997; Johkura et al., 1998;
Peretz, Kolinky, Tramo et al., 1994; Sparr, 1999). Left hemisphere lesions can
cause a “rhythm agnosia” with abnormal recognition of simple rhythm patterns
(Assal and Buttet, 1983; Mavlov, 1980). Although impairment of music
perception occurs in most cases of auditory agnosia (Gates and Bradshaw,
1973), the musical quality of sound stimuli and musical pleasure may be
differentially spared (LeChevalier, Rossa, Eustache et al., 1984). Despite his
anomia in naming melodies, NS demonstrated intact perception of the musical
quality of sounds and of rhythm.
The presence of left-handedness and probable bilateral representation of
language complicates the interpretation of this patient’s generalized auditory
agnosia. NS had significant anomia on confrontational naming, supporting the
participation of the right hemisphere in language production. There was no
evidence on either MRI and PET imaging of a second lesion in the left temporal
lobe that might otherwise explain his anomia. Furthermore the presence of right
ear advantage in dichotic test may reflect right temporal lobe damage more than
the integrity of language functions in the left hemisphere.
In conclusion, this unusual patient adds to our understanding of generalized
auditory agnosia. NS may have a deficit in integrating sounds into a temporal
holistic pattern distinct from rhythm and music recognition (Hupfer, Jurgens and
Ploog, 1977). As in patients with selective auditory agnosia, his right
hemisphere is preferentially involved in acoustically processing environmental
sounds. In contrast to most patients, however, his left Wernicke’s area appears to
depends on speech input from his damaged right temporal lobe. This may be due
to a lateralization of fine temporal auditory processing in his right auditory areas
rather than in the left. Finally, the bilateral representation of language in this
left-handed patient confounds the interpretation of these results, and further work
is needed to clarify these relationships.
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M. Mendez, Neurobehavior Unit (116AF), V.A. Greater Los Angeles Healthcare System, 11301 Wilshire Blvd., Los Angeles, CA
90073, U.S.A. E-mail: mmendez@ucla.edu

(Received 3 April 2000; reviewed 11 May 2000; revised 21 June 2000; accepted 11 July
2000)