[Clinico-experimental study of auditory-speech agnosia (case with anatomo-histologic verification)]

Under observation there was a female patient (a right-hander) who had three ischemic cerebral strokes within a year. After the first stroke she developed an amnestic-sensory aphasia, after the second an auditory and speech agnosia with a complete loss of the ability to understand the speech addressed to her, and after the third stroke she died. Macro- and microscopic examinations showed that the first stroke caused a destruction in the region of the left temporal lobe cortex involving a part of the Heschl convolution; the second stroke resulted in destruction of the right temporal lobe involving almost the whole Heschl convolution. Thus, it has been confirmed that the syndrome can develop only in case of a grave bitemporal damage. Comparative examinations of the speech and audition after the first and the second stroke have shown that in auditory and speech agnosia, the auditory discernment of phonemes, their combinations and the speech prosodic elements is pronouncedly deranged, the formation of conditioned reflexes to sounds of a supraliminal force is disturbed, the detection of short acoustic messages and acoustic filtration are hampered (mainly on the side contralateral to the affected one) the amusia gets more marked and the discernment of rhythms more difficult. All these disturbances are highly dynamic. A question on the role of defects of the right and the left hemispheres in the clinical picture of the auditory and speech agnosia is discussed.