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Taken together, these data suggest that the nondominant hemisphere is important for the recognition of harmony and melody (in the absence of words), but that the naming of musical scores and all the semantic (writing and reading) aspects of music require the integrity of the dominant temporal and probably the frontal lobes as well Word-Deafness (Auditory Verbal Agnosia) In essence, worddeafness is a failure of the left temporal lobe function in decoding the acoustic signals of speech and converting them into understandable words This is the essential element of Wernicke s aphasia and is discussed on page 421 However, word-deafness can occur by itself, without other features of Wernicke s aphasia Also, as mentioned above, verbal agnosia may be combined with agnosia for sounds and music, or the two may occur separately Auditory Illusions Temporal lobe lesions that leave hearing intact may cause a hearing disorder in which sounds are perceived as being louder or less loud than normal Sounds or words may seem strange or disagreeable, or they may seem to be repeated, a kind of sensory perseveration If auditory hallucinations are also present, they may undergo similar alterations Such paracusias may last inde nitely and, by changing timbre or tonality, alter musical appreciation as well Auditory Hallucinations (See also Chap 15) With lesions of the temporal lobes, these may be elementary (murmurs, blowing, sound of running water or motors, whistles, clangs, sirens, etc), or they may be complex (musical themes, choruses, voices) Usually sounds and musical themes are heard more clearly than voices Patients may recognize hallucinations for what they are, or they may be convinced that the voices are real and respond to them with intense emotion Hearing may fade before or during the hallucination In temporal lobe epilepsy, the auditory hallucinations are known to occur alone or in combination with visual or gustatory hallucinations, visual distortions, dizziness, and aphasia There may be hallucinations based on remembered experiences (experiential hallucinations, in the terminology of Pen eld and Rasmussen) The anatomy of lesions underlying auditory illusions and hallucinations has been incompletely studied In some instances these sensory phenomena have been combined with auditory verbal (or nonverbal) agnosia; the superior and posterior parts of the dominant or both temporal lobes were then involved Clinicoanatomic correlation is dif cult in cases associated with tumors that distort the brain without completely destroying it and that also cause edema of the surrounding tissue Moreover, it is often uncertain whether symptoms have been produced by destruction of tissue or by excitation, ie, by way of seizure discharges, which act in a fashion similar to electrical stimulation of the auditory cortical areas Elementary hallucinations and dreamy states have been reported with lesions of either temporal lobe, whereas the more complex auditory hallucinations and particularly polymodal ones (visual plus auditory) occur more often with left-sided lesions It should also be noted that complex but unformed auditory hallucinations (eg, the sound of an orchestra tuning up), as well as entire strains of music and singing, occur with lesions that appear to be restricted to the pons (pontine auditory hallucinosis, as noted in Chap 15) It is tempting to relate complex auditory hallucinations to disorders in the auditory association areas surrounding Heschl s gyri,. opening pdf file in asp.net c# How to open PDF file into iframe from server folder in UI for ASP ...
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