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The Neglected Neglect Auditory Neglect

Sankalp Gokhale, MD1; Sourabh Lahoti, MD2; Louis R. Caplan, MD3
[+] Author Affiliations
1Department of Neurology, Duke University Hospital, Duke University School of Medicine, Durham, North Carolina
2Department of Neurology, University of Kentucky School of Medicine, Lexington, Kentucky
3Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
JAMA Neurol. 2013;70(8):1065-1069. doi:10.1001/jamaneurol.2013.155.
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Whereas visual and somatosensory forms of neglect are commonly recognized by clinicians, auditory neglect is often not assessed and therefore neglected. The auditory cortical processing system can be functionally classified into 2 distinct pathways. These 2 distinct functional pathways deal with recognition of sound (“what” pathway) and the directional attributes of the sound (“where” pathway). Lesions of higher auditory pathways produce distinct clinical features. Clinical bedside evaluation of auditory neglect is often difficult because of coexisting neurological deficits and the binaural nature of auditory inputs. In addition, auditory neglect and auditory extinction may show varying degrees of overlap, which makes the assessment even harder. Shielding one ear from the other as well as separating the ear from space is therefore critical for accurate assessment of auditory neglect. This can be achieved by use of specialized auditory tests (dichotic tasks and sound localization tests) for accurate interpretation of deficits. Herein, we have reviewed auditory neglect with an emphasis on the functional anatomy, clinical evaluation, and basic principles of specialized auditory tests.

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Figure.
Lateral Schematic View of the Human Brain Demonstrating Higher Functional Organization of the Auditory System

The cortical auditory processing system is organized into 4 levels of hierarchy as follows: (1) the core, (2) the belt, which is further divided into anterolateral (AL) and caudolateral (CL) components, (3) the parabelt, with broad functional divisions into AL and CL components with close connections with respective belt components, and (4) two distinct functional pathways, a dorsal pathway that deals with directional attributes of sound (spatial localization with connections to areas involved with frontal eye fields and working memory) and a ventral pathway that deals with identification of sound, tones, and pitch (identification of source of sound with connections to areas involved with emotions and motivation). A indicates anterior; D, dorsal; P, posterior; and V, ventral. Bidirectional arrows indicate connections in either direction. Thick curved arrows indicate dorsal (top) and ventral (bottom) pathways.

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