![]() ![]() Within each sequence the x-axis represents time, and the y-axis pitch height. The first six tasks followed a 2-alternative forced-choice paradigm, while the last two tasks (metre disruption and dynamic ripple discrimination) followed an ‘odd-one-out’ paradigm, again with two alternatives (and one template). The patient had a borderline performance on a test of contour (the pattern of pitch rises and falls) and was below cut-off for interval (degree of pitch change), scale (keeping in the same key), metre (march or waltz), rhythm and melodic memory ( table 1).Ĭartoon illustrating the psychophysical tasks performed by the patient. 1 This assesses melodic and rhythmical structure systematically with a same–different task applied to pairs of novel melodies. ![]() Musical deficits were confirmed then by his performance on the Montreal battery of assessment of amusia. ![]() In contrast to speech, 4 years after the second haemorrhage he still could not recognise music. More detailed testing of speech perception 4 years after the second event found a significantly impaired ability to distinguish minimal pairs of real words (eg, bear vs pear) but excellent performance distinguishing words from non-words (eg, bus vs mus). This coincided with a gradual improvement in speech reception threshold (the minimum volume at which a patient can understand 50% of simple consonant-vowel-consonant words). The average responses to three sets of right-sided clicks are in magenta at the top of the panel these responses are abnormal, as there is no convincing presence of wave V, and the wave IV response is of small amplitude.įollowing audiology advice, during the 4 years after the second haemorrhage, he managed to retrain his understanding of speech by reading printed books while listening to the corresponding audiobook. The average responses to three sets of left-sided clicks are in blue at the bottom of the panel these responses are normal. The patient's auditory brainstem responses to clicks taken 4 years after the second haemorrhage (unchanged from 4 years previously). He had no comprehension of speech, and suffered extremely loud and troublesome bilateral tonal tinnitus. By discharge on day 14, he was aware of noises occurring but could not characterise them. The following day, he was fully conscious and orientated and able to communicate with whiteboard and pen. Unenhanced CT of the head showed an isolated haemorrhage of the left inferior colliculus ( figure 2) with obstruction of the cerebral aqueduct and consequent hydrocephalus. Over the next 12 h, his Glasgow Coma Scale score fell from 15 to 8 (E1, V2, M5) and his blood pressure rose to 214/76 mm Hg. Neurological examination was normal except for diplopia on left gaze, and his systolic blood pressure was 156/95 mm Hg. He attended hospital, where it quickly became clear that he was completely deaf. He was disorientated, vomited and complained of headache and numbness of the right arm. The area of haemorrhage involves almost the whole right temporal lobe, and extends into right parietal regions.įour years later, he was woken from sleep by a tremendously loud noise, “like a spaceship landing”. Unenhanced CT scan of head at the time of the first infarction. He described no new symptoms related to his hearing after the first episode. Sometime later, 24-h ambulatory blood pressure monitoring was normal while taking amlodipine and ramipril. He was discharged on day 28 with residual left hemianopia/neglect, and eventually made it back to work on reduced duties. He required 10 days in the high-dependency unit, primarily to control his elevated blood pressure, followed by rehabilitation on the stroke ward. Digital subtraction angiography of brain was normal. Immediate unenhanced CT of the head showed an extensive lobar haemorrhage, involving most of the right temporal lobe with some parietal lobe extension ( figure 1). Neurological examination identified a left upper motor neurone facial palsy with preserved limb power, left-sided sensory and visual neglect, left-sided hyper-reflexia and left extensor plantar response. Initial physical examination showed no injuries but his blood pressure was 230/120 mm Hg. The ambulance crew found him to be confused and complaining of headache and nausea, so brought him to hospital. After the second incident, he pulled over and called an ambulance, as he felt ‘disorientated’. The first was nose-to-tail, as he failed to see the car in front stop in traffic, and the second was nose-to-nose with a parked car. He suffered two low-speed road traffic accidents in a single journey on the way to work. He had no previous symptoms relating to environmental sound or speech perception. The patient was a 48-year-old, right-handed salesman who was a keen listener to popular music.
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