Posterior cerebral artery infarcts and semantic category dissociations: a study of 28 patients.

In this study we analysed the relationship between damage in the territory of the posterior cerebral artery and semantic knowledge, with special reference to category dissociations. Twenty-eight posterior cerebral artery stroke patients (18 left, 8 right and 2 bilateral posterior cerebral artery infarctions) completed a neuropsychological battery aimed at assessing semantic knowledge. The battery included picture naming, word-picture matching, a verbal semantic questionnaire and a picture reality decision task. For each participant, the lesion was reconstructed on the basis of MRI images, and was classified according to the involvement of the areas supplied by posterior cerebral artery. Defective naming scores were observed in 12 of 18 left posterior cerebral artery cases (67%), four of eight right posterior cerebral artery cases (50%), and one of two bilateral posterior cerebral artery cases (50%). Only in the bilateral posterior cerebral artery lesion case did we observe the pattern expected in pure visual agnosia, i.e. poor picture naming, poor picture reality decision, and normal verbal semantic questionnaire. Nine left posterior cerebral artery cases and two right posterior cerebral artery cases presented with poor performance on both the picture naming task and the verbal semantic questionnaire, thus suggesting semantic impairment. For 5 of the 12 left posterior cerebral artery patients who fared poorly on the naming task, biological stimuli (overall) were significantly more impaired than artifacts. In three of these five subjects, performance on plant-life stimuli was significantly less accurate than that on animals. A further left posterior cerebral artery patient presented a disproportionate impairment on plant-life stimuli only on the word-picture matching and on the questionnaire. The patterns of performance in these subjects suggest that the observed dissociations originated at the semantic level. Among left posterior cerebral artery patients, a naming deficit only occurred when damage to the fusiform gyrus extended anterior to Talairach's y-coordinate -50, and a disproportionate impairment of biological categories only when the lesion extended anterior to y = -32.5. Results show that the semantic deficit for the category of plant life is a genuine cognitive pattern, and does not depend on loss of colour knowledge. The contrast of left posterior cerebral artery strokes and herpes simplex encephalitis cases shows that the neural substrates for the semantic representation of plant life and animals are, at least in part, distinct. Middle and posterior portions of the left fusiform are crucial for the representation of plant-life knowledge, whereas left anterior temporal areas are more crucial than left posterior and basal temporal areas for the representation of knowledge about animals.

Acute auditory agnosia as the presenting hearing disorder in MELAS.

MELAS is commonly associated with peripheral hearing loss. Auditory agnosia is a rare cortical auditory impairment, usually due to bilateral temporal damage. We document, for the first time, auditory agnosia as the presenting hearing disorder in MELAS. A young woman with MELAS (A3243G mtDNA mutation) suffered from acute cortical hearing damage following a single stroke-like episode, in the absence of previous hearing deficits. Audiometric testing showed marked central hearing impairment and very mild sensorineural hearing loss. MRI documented bilateral, acute lesions to superior temporal regions. Neuropsychological tests demonstrated auditory agnosia without aphasia. Our data and a review of published reports show that cortical auditory disorders are relatively frequent in MELAS, probably due to the strikingly high incidence of bilateral and symmetric damage following stroke-like episodes. Acute auditory agnosia can be the presenting hearing deficit in MELAS and, conversely, MELAS should be suspected in young adults with sudden hearing loss.

Idiom comprehension in aphasic patients.

Idiom comprehension was assessed in 10 aphasic patients with semantic deficits by means of a string-to-picture matching task. Patients were also submitted to an oral explanation of the same idioms, and to a word comprehension task. The stimuli of this last task were the words following the verb in the idioms. Idiom comprehension was severely impaired, with a bias toward the literal interpretation. Very few errors were produced with words, making impossible to establish a correlation between comprehension of idioms and of individual words. The difficulties in idiom comprehension seemed to be due to the fact that patients rely on a literal-first strategy, accessing a figurative interpretation only when the linguistic analysis fails to yield acceptable results.