Defective auditory recognition after small hemorrhage in the inferior colliculi.

We report the case of a male patient with a traumatic small hemorrhage partially involving the bilateral inferior colliculi without evidence of a temporal lobe lesion. He was unable to comprehend spoken words although he had intact speech production, reading and writing abilities. Comprehension of environmental sounds was also affected. Among the receptive musical abilities, discrimination of intensity, tone and rhythm were preserved, while recognition of melody was impaired. Audiometry showed normal thresholds for pure tone. Waves I-IV of brainstem auditory evoked potentials were elicited normally, whereas the wave V was elicited with reduced amplitude and prolonged latencies on both sides. The main component of middle latency auditory evoked potentials, which is evoked over both hemispheres by monaural stimulation to either side in normal subjects, was elicited only over the hemisphere contralateral to the ear receiving stimulation. Our patient's auditory findings were similar to those usually found in generalized auditory agnosia. Auditory agnosia is usually considered as a sign of a bitemporal cortical or subcortical disorder, but, in our patient, a brainstem disorder caused a disturbance of auditory recognition similar to auditory agnosia due to a bitemporal lesion. Our patient's auditory findings may belong to the category of a brainstem auditory-processing disorder brought on by a small hemorrhage in the inferior colliculi. In addition, the impairment in our patient implies that, in the neural processing of musical parameters, the decoding of intensity, tone and rhythm is accomplished at the level of inferior colliculus, whereas further cortical processing is necessary for the appropriate recognition of melody.