Neurocase
The Neural Basis of Cognition

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Pure word deafness due to bilateral temporal
lobe ischemic stroke occurring at different time
points over the years: a case report on the insight
of brain language network reorganization
Ioanna‐Eleni Virvidaki, Lambros Messinis & Grigorios Nasios
To cite this article: Ioanna‐Eleni Virvidaki, Lambros Messinis & Grigorios Nasios (2021) Pure word
deafness due to bilateral temporal lobe ischemic stroke occurring at different time points over the
years: a case report on the insight of brain language network reorganization, Neurocase, 27:1,
106-112, DOI: 10.1080/13554794.2021.1896744
To link to this article: https://doi.org/10.1080/13554794.2021.1896744

Published online: 09 Mar 2021.

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NEUROCASE
2021, VOL. 27, NO. 1, 106–112
https://doi.org/10.1080/13554794.2021.1896744

Pure word deafness due to bilateral temporal lobe ischemic stroke occurring at
different time points over the years: a case report on the insight of brain language
network reorganization
Ioanna-Eleni Virvidakia, Lambros Messinisb and Grigorios Nasiosa
a

Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina, Ioannina, Greece; bNeuropsychology Section,
Departments of Neurology and Psychiatry, University of Patras Medical School, Patras, Greece
ABSTRACT

ARTICLE HISTORY

Here we present a case of a native Greek male patient who presented clinically with sudden onset pure
word deafness after an ischemic stroke in the temporoparietal region of the right hemisphere, but who
had suffered an ischemic stroke 9 years previously in an adjacent area of the left hemisphere, causing
aphasic symptoms which resolved quickly and almost completely. What makes this case interesting and
novel is that it is the first case describing a patient whose ventral language comprehension circuit did not
reorganize successfully due to damage of the adjacent right hemisphere language areas at a subsequent
time.

Received 16 December 2020
Accepted 24 February 2021
KEYWORDS

Pure word deafness; stroke;
temporal lesions; language
comprehension

Introduction
Pure word deafness (PWD) is a rare, neurological disorder char­
acterized by marked difficulty in comprehending spoken lan­
guage but spared written comprehension and speech
production (Kussmaul, 1877; Lichteim, 1885). In its true “pure”
form, the coined term has been debated because it presumably
should only be applied to patients with isolated auditory
impairments for speech sounds (Poeppel, 2001). However,
more commonly it has been applied to patients with dispropor­
tionate but not selective deficits in auditory input processing
for verbal stimuli and irrespective of coexisting aphasia and/or
agraphia (Maffei et al., 2017).
In most reported cases, PWD is acquired after bilateral
damage to the temporal lobes (Geschwind, 1965; Miceli et al.,
2008; Poeppel, 2001; Slotwinski et al., 2020). Less frequently it
has been described following subcortical or cortical-subcortical
lesions (Hayashi & Hayashi, 2007; Taniwaki et al., 2000) or iso­
lated left temporal lesions (Hayashi & Hayashi, 2007; Maffei
et al., 2017; Slevc et al., 2011; Wang et al., 2000) further provid­
ing evidence favoring the disconnection hypothesis of PWD. It
is mostly documented in adults with acute stroke or head
trauma but has also been reported in children with LandauKleffner syndrome (Baynes et al., 1998) and brain tumor (Chou
et al., 2011). Literature also reveals cases of PWD caused by
osmotic demyelination syndromes (Garde & Cowey, 1998; Zhu
et al., 2010), neurodegenerative diseases (Kim et al., 2011;
Lizuka et al., 2007; Otsuki et al., 1998) multiple sclerosis
(Tabira et al., 1981; Jónsdóttir et al., 1998), encephalitis
(Goldstein, 1974; Arias et al., 1995; Kasselimis et al., 2017)
seizures (Fung et al., 2000; Stefanatos et al., 2005), mitochon­
drial encephalomyopathy (Miceli et al., 2008), Creutzfeldt-Jakob

CONTACT Grigorios Nasios
Ioannina, Greece

grigoriosnasios@gmail.com

© 2021 Informa UK Limited, trading as Taylor & Francis Group

disease (Hillis & Selnes, 1999; Tobias et al., 1994), and drug
toxicity (Donaldson et al., 1981).
Auditory processing disorders vary in severity, duration, and
quality depending on lesion size and location (Maffei et al.,
2017). In severe forms of the disorder, patients may not react
voluntarily to auditory stimuli and behave as if they were deaf,
although they retain some ability to respond reflexively to
sounds (Garde & Cowey, 1998). The least impaired patients
may voluntarily be able to detect or identify auditory stimuli
but present with difficulties in accurately processing these
sounds (Ishii et al., 1995; Maffei et al., 2017).
Patients’ subjective descriptions are intriguing and seem to
also vary in published reports suggesting a continuum of
severity (Stefanatos et al., 2005). Some case studies highlight
marked impedance in recognizing the acoustic characteristics
of a human voice while others have alluded to subtler difficul­
ties mapping the acoustic features of speech to lexical repre­
sentations (Stefanatos et al., 2005). Historically, speech has
been described as “a great noise all the time . . . you think you
can catch it and it fades away” (Buchman et al., 1986; Coslett
et al., 1984), “a hurr or buzzing” (Mendez & Geehan, 1988)
“foreign folks speaking in the distance” (Auerbach et al., 1982;
Klein & Harper, 1956; Stefanatos et al., 2005) or simply “I can
hear you talking but I can’t translate it” (Kanshepolsky et al.,
1973) or “does not register” (Saffran et al., 1976). Other patients
describe their auditory experience as “words come too quickly”
(Albert & Bear, 1974) or “just run together” (Klein & Harper,
1956), reflecting partially intact ability to capture qualitative
information from the speaker’s voice but that maybe percep­
tual or cognitive resources cannot keep up with the rate of
speech production (Stefanatos, 2008).

Department of Speech and Language Therapy, School of Health Sciences, University of Ioannina,

NEUROCASE

Accumulating evidence suggests that the speech percep­
tion difficulties in PWD reflect underlying deficits in rapid
temporal processing (Poeppel, 2001; Slevc et al., 2011;
Stefanatos, 2008). This claim is supported by the observation
that patients with PWD typically demonstrate difficulties per­
ceiving temporally dynamic features of consonants (especially
changes in place of articulation and voicing in stop conso­
nants) rather than steady state stimuli like vowels (Slevc,
2012). Several different explanations have been proposed
regarding speech processing and hemispheric specializations.
Neuroimaging studies involving patients with temporoparie­
tal damage and non-brain-damaged participants suggest
a plausible left hemispheric bias for processing the temporal
aspects of sound and a right hemispheric preference for pro­
cessing the spectral aspects of sound (Robin et al., 1990; Scott
& Wise, 2004; Slevc, 2012; Warrier et al., 2009).
In this study, we present a case of pure word deafness with
preexisting cognitive-communication disorder due to stroke
and necrosis of the left temporoparietal area which did not
threaten the patient’s functional independence in performing
daily activities. However, ischemic necrosis of the temporopar­
ietal area in the right hemisphere owing to a second stroke
years later, contributed to the clinical presentation we describe
and discuss in terms of the functional organization of the
language circuitry.

Case report

107

Neuropsychological and speech-language evaluations were
performed 3 weeks after the onset of his problems in auditory
recognition. Both cognition and communication were affected
after the second ischemic event, and AM reported his situation
frustrating and isolating at times. His general physical condition
was normal. Neurological examination revealed no signs of
paresis, sensory or visual field deficits. Lack of access to initial
clinical assessment data prevented the inclusion of language
testing procedures to serve as a baseline for the testing con­
ducted after the second stroke. AM gave permission for his
history and medical information to be published.

Personal account
AM never complained of auditory disorders before his strokes. He
displayed an awareness of his deficit in understanding spoken
language. The following self-reported perspective is a free trans­
lation from Greek: “this is where I get confused and I cannot make
the discrimination-I cannot understand . . . it feels as though “this”
(pointing to his brain) is constantly foggy. I cannot perceive mean­
ings, do you understand? I mean I can read, I can do things I used to
do, but I cannot listen. I watch TV, I read on the internet. I can
understand what I am reading but I cannot recognize what I hear.
When I listen to the news, some things are recognized, others are
lost. Later in our communicative exchange, he noted, “I can hear
the doorbell ring, but I cannot hear you speak . . . and then, I cannot
express myself. I hear people talk but I cannot express myself”. He
continues (sighing) “we have a long way to go”.

Background information
AM (initials deliberately changed) is a right-handed, native
Greek man who in 2010, at age 60, suffered a heart attack
followed by a stroke, involving extensive lesions in the tempor­
oparietal areas of the left hemisphere, with the superior tem­
poral gyrus (STG) identified as the core ischemic lesion site (see
Figures 1&2). He had idiopathic hypertension since the age of
50 and was a smoker (40 pack/years, until the myocardial
infarction occurred). When hospitalized for a heart attack, he
was additionally diagnosed with diabetes mellitus type 2. He is
a retired post office employee and lives with his wife. He is also
a grandfather with three grandchildren.
At the onset, he exhibited signs of a broader aphasic dis­
turbance resembling a severe Broca’s aphasia. His family
reports an initial inability to formulate language which rapidly
resolved in the first few weeks. Language abilities improved
significantly over the course of a few months during which
time, the patient also received speech and language therapy
services. The 2010 language disorder was diagnosed as expres­
sive in nature although the brain lesion was mainly parietotem­
poral. We did not have access to initial clinical assessment data
as the patient was cared for in his hometown, a small town in
the Epirus region in northwestern Greece. Retrospectively, one
could argue that the aphasic syndrome could be better
approached as conduction aphasia. Both the patient and his
communication partners highlight that they did not expect
such a rapid recovery of language abilities to a state of ade­
quate use of language in every-day functional communication.
At the end of 2018, AM suffered a second stroke involving
the adjacent temporoparietal region in the right hemisphere.

Neuroimaging
Magnetic resonance imaging (MRI) performed 3 weeks after his
2018 stroke showed the presence of rather symmetrical lesions
involving mainly temporal and parietal perisylvian regions but
sparing the frontal lobes. The left-hemispheric lesion character­
istics were chronic in nature, whereas the right lesion was in
line with subacute origin. Both sides showed extensive damage
to the STG (Figure 1 & Figure 2)

Initial clinical setting
Pure-tone audiometry testing was initially performed to mea­
sure the level of hearing acuity of our patient. Normal hearing
thresholds were revealed. Subsequent neurolinguistic assess­
ment with AM was undertaken in Greek, the only language the
patient spoke. We used formal and informal assessment proce­
dures. The entire evaluation was completed in two visits sepa­
rated by 1 week. When AM could not understand a question,
written instructions in Greek were provided.
The patient was alert and oriented for time, place, and person.
His general ability to engage in communication interchange was
poor. His comprehension of daily conversation was enhanced
when the conversational partner used gestural and excess pro­
sodic cues (such as increased contrastive stress and intonation
patterns and slower speech). AM understood his problem and
was frustrated by it. He could augment auditory comprehension
with lip reading although he could not lip read without hearing
the voice. His conversational speech was fluent and grammati­
cally correct with normal phrase length but with occasional

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I. VIRVIDAKI ET AL.

Figure 1. Axonal T2 (left) and T1 MR images (center) and coronal T1 image of the chronic (left) and subacute (right) ischemic lesions of patient AM.

Figure 2. MR T2 dark-fluid axonal sequences, revealing bilateral, mainly temporal, ischemic lesions.

paraphasic errors. Praxis was normal as assessed via a modified
version of the Apraxia Battery for Adults-2 (Dabul, 2000). AM
flawlessly and articulately produced automated sequences.

Assessment of language
Formal assessment of language via the Boston Diagnostic
Aphasia Examination-2nd ed (Goodglass & Kaplan, 1972)
revealed marked deficits in auditory language comprehension
and repetition. Subtests were performed without restrictions
on lip reading. His performance on word recognition, body part
discrimination, written words to dictation, and repetition dete­
riorated when lip reading was not allowed.
AM presented with defective auditory verbal comprehen­
sion. He displayed difficulty following sequential commands
(“point to the window and then the door”) and answering
biographical/nonbiographical questions requiring a basic yes/
no response. He had better, yet not complete, success in
responding to biographic questions. He was able to recognize
most body parts, colors, real objects, numbers, and letters (less
proficiency with color identification, 2/5). Assessment of sen­
tence-level auditory comprehension revealed more pro­
nounced deficits. AM scored 1/5 (20%) on all respective
matching subtests measuring syntactic processing.
By contrast, expressive communication ability was relatively
preserved. His verbal output in spontaneous speech and pic­
ture description tasks retained fluency, functional content, and
adequate prosodic features (intonation, stress, rhythm).
Connected narratives of daily life activities included meaningful
and grammatically correct sentences. Rare literal paraphasias
were noted (e.g., “provavizome” vs “provivazome”) which
appeared to be related to periodic lapses in self-monitoring.
Similarly, instances of logorrhea or increased speech output
were observed at the initiation of tasks that required him to
respond non-verbally (e.g., by pointing).

Oral reading (reading aloud) ability was intact for all levels of
sentences and paragraph complexity. Comprehension of writ­
ten material was intact for simple sentences but displayed
impairments for more lengthy, complex sentences and para­
graphs. His ability to correctly repeat single words displayed
some accuracy over time (first visit: 1/10, second visit: 6/10 with
one repetition allowed). However, repetition was severely
impaired at the phrase and sentence level (0/5 correct).
His ability to write to dictation was spared up to a word level.
AM correctly wrote upon request his name and address, numbers,
letters, syllables, and words with four syllables. His “breakdown”
appeared to occur at the phrase and sentence level where he
relied on more contextual cues and multiple repetitions to pre­
pare his response. He had great difficulty answering situational
questions provided through the auditory channel (e.g., what is the
weather like outside?). By contrast, he made no mistakes in
answering written questions, writing spontaneously, and copying.
Performance on the Boston Naming Test, second ed (Kaplan
et al., 2001) was moderately impaired. In this confrontation
naming task involving 60-line drawings of objects with graded
difficulty, AM scored 42/60 (65%). An evaluation of error types
and examples of those errors are listed in Table 1.

*BNT; Boston naming test
It is worth noting that AM produced four more errors (three at
the phonological level and one at the semantic level) which he
spontaneously self-corrected and thus, was given credit. These
errors reflect AM’s difficulties retrieving the target word.
Accordingly, lenient scoring was used for two items for which
synonyms were provided in a pilot study including normative
data on this test for healthy Greek speakers (Patricacou et al.,
2007). Finally, performance on sentence completion and
responsive speech tasks was poor (20%) secondary to his com­
prehension deficits.

NEUROCASE

Table 1. An analysis of AM’s observed error types on the BNT*.
Error Types
No response
(3)
Misperception
(1)
Semantic (7)

Definition
No attempt to name the object

Examples
“don’t know what this
is” for “seahorse”
A visual misperception of the
“person with legs” for
pictured object
“Sphinx”
a) Production of the category name a) “this is a musical
b) Production of a related member
instrument” for
c) Associated with the concept
“harp”
b) “seagull” for
“pelican”
c) “paintbrushes” for
“palette”
Phonemic (8) Mispronounced word preserving
“taniera” for “tenis”,
half of the components of the
“athimotrio” for
target word
“arithmitirio”
Neologistic (2) Less than 50% of phonemes
“femanestra” for
common with the target word
“siðero”, “valani” for
“rhinoceros”

Further Assessment of Language Processing/Processing of
Verbal Stimuli:
Subtests from the Psycholinguistic Assessments of
Language in Aphasia (PALPA) (Kay et al., 1992), were adjusted
and presented to investigate AM’s ability to carry out auditory
input processing at various levels. During all auditory tasks, AM
was not allowed to see the examiner’s mouth but was offered
written instructions before initiating each task.
AM completed auditory lexical decision tasks whereby he
was required to make perceptual judgments on 30 pairs of
constructed, nonsense words, and meaningful real words by
responding with a yes/no response (word/non-word). Half of
the pseudowords had a change in a distinctive feature in
a single phoneme in a different place of articulation (e.g.,
“hironas” from “himonas”). The other half was created by mov­
ing a phonemic sequence to a different place in the word (e.g.,
“patharytho” from “parathyro”). AM’s performance was 67% for
words and non-words combined and was marked by some
hesitations. AM could not recognize five actual words and five
non-words. Healthy controls performed at 97.1% correct.
Similarly, AM’s performance on tasks requiring him to use
non-lexical routes and repeat nonsense words was remarkably
poor. Strict scoring for entirely correct responses provided a 0%
score, however, it is interesting to note that his responses
revealed partially correct phonemic identification and that all
but one mistake involved difficulties perceiving consonants,
typically occupying the initial word position (e.g., “kotiri” vs
“potiri”).
Additionally, a homophone matching task was administered
whereby 14 sets of common words were recorded and pre­
sented auditorily for the patient to indicate (verbally or via
pointing to two written choices same/different) whether the
two words had identical or non-identical pronunciations. AM
achieved 57% correct (8/14). Normal controls obtained 100%
correct on this task. AM’s performance was poor but above
chance. Error analysis again reveals a specific difficulty in dis­
criminating distinctive phonemic features, namely, differences
in voicing (voiced/voiceless consonant) and place of articula­
tion (labial, alveolar, and velar).
By contrast, 32 words with a CVCV combination were
recorded and presented auditorily. Following a 2-s interval,
the patient was asked to match the spoken word to one of

109

the two written alternatives, one matching the heard word and
one being used as a phonological distracter. AM fared better in
this task supported by the visual modality (27/32, 86% correct).
Unimpaired participants performed at 98% correct.
Finally, AM was required to make semantic judgments with
sentences presented initially auditorily and then followed by
a task utilizing the same stimuli presented through the visual
channel. AM’s performance was 9/15 (60%) and 13/15 (87%)
respectively. His ability to access the semantic system via the
auditory modality significantly relied on the repetition of the
content and more contextual cues (effective speech with
allowed pauses).

Auditory processing of non-verbal stimuli
The ability of AM to process environmental sounds and music
was tested in several tasks. Each task was also performed by 10
healthy, age-, and education-matched controls. Our patient
was asked to identify a set of 32 recorded environmental
sounds corresponding to one of the four sound categories: (1)
animal/bird sounds, (2) transport vehicles, (3) household/tool
sounds, and (4) recreational/sport activities. The sounds were
presented in a randomized order among the tested categories
and the patient heard the stimulus twice before identifying it.
After hearing each sound, he was asked to point to the corre­
sponding picture in a four-alternative field response paradigm.
Each response card included a pictorial representation corre­
sponding to the target, while the three others were semantic
foils from the same semantic category. AM’s overall perfor­
mance in sound recognition was 72% correct (23/32). He cor­
rected identified 6/8 animal/bird sounds, 6/8 vehicles, 7/8
household/tool sounds, and 4/8 recreational/sport activities.
AM showed difficulty recognizing horseback riding, boating,
swimming, and the sound of table tennis. The observed varia­
bility in the latter category may possibly be related to lowintensity sounds.
Several ancillary measures of auditory processing of nonverbal stimuli were also administered. AM was asked to name
the musical instrument producing a note and to establish if two
melodies were the same or different. His performance was not
significantly distinguishable from that of healthy volunteers in
terms of providing an accurate response but only in terms of
the time required to produce a response. AM was also able to
discriminate between a male and a female voice and between
Greek and non-Greek languages. He could further recognize
when the speaker’s voice was emotionally neutral, happy, or
angry. Finally, he could discriminate between laughter and crying.

Discussion
This case study is unique for numerous reasons. To our knowl­
edge, this is the first Greek-speaking person described with
clinical manifestations of this syndrome with the etiology of
a stroke. One case report has been recently published with
herpes simplex encephalitis by Kasselimis et al. (2017) with
interestingly similar neural substrates underpinning the audi­
tory comprehension deficits. Another reason is the time interval
between the incident ischemic event and the recurrent event
which contributed to our patient’s clinical profile. It is worth

110

I. VIRVIDAKI ET AL.

noting that AM did not complain of speech, language, or com­
munication difficulties during this lengthy 9-year period.
However, lack of access to the initial objective assessment of
language abilities constituted a limitation of our study and
prevented us from utilizing initial testing procedures as
a baseline protocol for the testing performed after the second
stroke.
AM’s initial clinical presentation of aphasia in 2010, consid­
ered severe, affecting mostly language expression, may be
explained partially by the diaschisis theory, which stipulates
further clinical encumbrance the first weeks after the destruc­
tive brain damage (Price et al., 2001; Warren et al., 2009). His
subsequent rapid recovery may be explained by the gradual
obviation of the diaschisis and the functional reorganization of
the language circuitry, which to a large extent had escaped
necrosis.
In fact, the right frontal lobes, a significant portion of the
left parietal lobe and the right hemisphere remained intact,
and his rapid recovery was grounded on their functional
reconnection. This explanation supports and strengthens
the dual-stream model of language processing (Hickok &
Poeppel, 2007). AM’s frontal and part of the dorsal language
network in addition to all the language centers and networks
of the bilaterally organized ventral circuit were spared,
thereby enhancing the reactivation of those “lost” left hemi­
sphere language areas and functions. The successful func­
tional reorganization of AM’s left anterolateral superior
temporal cortex and right anterior superior temporal cortex
has been shown to predict a positive language outcome after
the incident stroke (Warren et al., 2009). In this regard, our
patient remained functionally communicative until he suf­
fered the second ischemic stroke that destroyed the areas in
which reorganization was originally based and prompted the
severe communication deficit.
Our case study adds to the claim of a dual-stream model to
language processing and specifically a bilaterally organized ven­
tral stream “running” in both temporal lobes that mediate auditory
comprehension (Hickok & Poeppel, 2007). In ΑΜ, when the left
temporal lobe was damaged by the first-ever ischemic stroke,
language functions were quickly and effectively restored due to
the maintenance of the integrity of the right temporal networks.
We believe that during the 9-year time-lapse between the incident
and recurrent ischemic events, the destroyed left hemisphere
areas were “functionally hidden” (Nasios et al., 2019). Necrosis of
the right hemisphere areas, in isolation, was not expected to
impact the language and communicative abilities of AM, however,
severe deficits developed after the second stroke as the brain of
AM had no other residual areas to compensate for the new loss.
A recently published case report by Slotwinski et al. (2020) pre­
sented a patient with similar brain lesions when compared to our
patient AM but occurring with different time order. Specifically,
the authors confirmed an initial right temporal lesion that was not
associated with speech disturbances, followed by a new, acute,
left temporal lesion, revealing a cluster of features that suggested
pure word deafness in their patient (Slotwinski et al., 2020). This
consideration offers further supporting evidence for the bilateral
organization of the ventral networks for language comprehension,
supporting the dual-stream model. Similarly, in AM, the

maintenance of the right temporal centers was sufficient for the
patient to sustain functional communication. However, their sub­
sequent destruction consequently to the second stroke revealed
the value of the bilateral organization of the language compre­
hension networks.
Moreover, certain other factors tended to improve our
patient’s performance. Lip reading offered considerable
information for place of articulation. Consonants carry
more of the linguistic message than vowels. Consistent
with previous reports of PWD (Jacobs & Schneider, 2003;
Saffran et al., 1976; Shindo et al., 1991), AM appeared to
utilize lip reading to enhance auditory comprehension of
the spoken message. Similarly, in agreement with other
studies, his comprehension improved when the rate of
speech presented to him was slower (Albert & Bear, 1974;
Oppenheimer & Newcombe, 1978). This seems to emphasize
the importance of the temporal aspects of speech for its
processing.
Language assessment using the BDAE revealed that he
had significant deficits in auditory comprehension, syntactic
processing, repetition, writing to dictation, despite the pre­
sence of good reading, fluent speech, and spontaneous
writing. He made few paraphasic errors in his spontaneous
(running) utterances. This was more pronounced in the
confrontation naming task. The presence of aphasic symp­
toms as residua of a left-sided stroke was more likely to be
phonemic paraphasias than semantic paraphasias and could
be attributed to difficulty decoding and monitoring phonol­
ogy. AM also had semantically coded errors; thus, he also
displayed difficulties with accessing semantic knowledge.
Evidence of generalized auditory agnosia, i.e., the ability to
recognize environmental (nonverbal) sounds was not intact,
consistent with most documented reports (Garde & Cowey,
1998; Hurley et al., 2018; Taniwaki et al., 2000; Wang et al.,
2000).

Concluding comments
This is the first case describing a Greek-speaking person, whose
ventral language comprehension circuit did not undergo suc­
cessful reorganization due to a second ischemic event 9 years
after the incident stroke, which further damaged the adjacent
right hemisphere language areas. Our case provides an impor­
tant insight of brain language network reorganization, not only
revealing the value of bilateral organization of the language
comprehension networks but also serves as further supporting
evidence for the “dual contribution of local cortical and path­
way-level function to focal lesion effects on language proces­
sing” (Warren et al., 2009).

Acknowledgments
We are grateful to AM and his family members for sharing with us the long
road of recovery and their permission to publish this paper.

Disclosure statement
There was no funding source for this study.

NEUROCASE

Author contributions
IEV performed all language testing. GN is the patient’s neurologist. All
authors participated in the structuring and reviewing the manuscript.

Data availability
Original recording, MRI data, and other relevant information are all avail­
able in AM’s medical record file.

Informed consent
AM gave his permission for publishing his data by signing an informed
consent.

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