Short communication Neuroimaging features in a case of developmental central auditory processing disorder Min-Jeong Kim a , Hyeon-Ae Jeon b , Kyoung-Min Lee c, ⁎, Young-Don Son b , Young-Bo Kim b , Zang-Hee Cho b, ⁎ a Department of Neurology, National Police Hospital, 58 Karak-Bon-Dong, Songpa-Gu, Seoul, 138-708, Republic of Korea b Neuroscience Research Institute, Gachon Medical School,1198 Kuwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea c Department of Neurology, Seoul National University Hospital, 28 Yeongeon-Dong, Jongno-Gu, Seoul,110-744, Republic of Korea abstract article info Article history: Received 6 March 2008 Received in revised form 23 September 2008 Accepted 14 October 2008 Available online 6 December 2008 Keywords: Auditory perceptual disorders Auditory diseases Central Auditory cortex Positron-emission tomography Magnetic resonance imaging We describe a case of developmental central auditory processing disorder (CAPD) that was diagnosed with a multidisciplinary approach including structural and functional neuroimaging. A patient with developmental CAPD was investigated using diagnostic tools of MRI and 18 F-FDG HRRT-PET as well as neuropsychology and electrophysiology. Besides impaired auditory processing, our patient also showed some impediments in supramodal, cognitive and linguistic processes. His MRI showed selective atrophy in the bilateral auditory cortices, and the PET images showed hypometabolism in the bilateral auditory cortices and the precuneus. Such a multidisciplinary diagnostic approach that includes neuroimaging methods will be helpful in differentiating developmental CAPD from other developmental cognitive disorders. © 2008 Elsevier B.V. All rights reserved. 1. Introduction Central auditory processing disorder (CAPD) is a heterogeneous and poorly understood listening impairment that is receiving increasing recognition. It refers to difficulties in the perceptual processing of auditory information in the CNS that underlie the following abilities or skills: sound localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of audition (distribution, masking, integration, ordering); auditory performance in competing acoustic signals; and auditory performance with degraded acoustic signals [1]. Central auditory processing disorder may result from delayed CNS maturation or other developmental disorders as well as acquired neurological disorders, and it appears to result predominantly from core malfunctioning of the central auditory system, but with strong cognitive influences and possible additional influences from peripheral auditory and cross- modal sources [2,3]. In the terminology of behavioral neurology, CAPD may be equated with apperceptive auditory agnosia. Auditory agnosia is an impaired capacity to recognize auditory stimuli despite a normal threshold for sound detection. Apperceptive auditory agnosia is a situation where unimodal processing of auditory information is abnormal to result in the recognition failure, while associative auditory agnosia is char- acterized by impairment in heteromodal processing of the auditory percept in relation to memory or other sensory modalities. In contrast to this neurological perspective which usually pertains to acquired forms of high-level auditory dysfunctions, CAPD is predominantly used by audiologists and speech-language pathologists for the diagnosis and management of developmental auditory disorders. CAPD patients are uncertain about what they hear and may have difficulty in listening in environments with background noise, following oral instructions, and understanding rapid or degraded speech in the presence of normal peripheral hearing. With develop- mental CAPD, symptoms may become apparent in the early school years or at a later academic stage due to changes in the acoustic environment or to increased academic demands [2]. As develop- mental CAPD can lead to or be associated with impediments in learning, speech, language, and social functions, the differential diagnosis very often becomes complicated between purely auditory disorders and those with abnormalities in other perceptual and cognitive domains. For the diagnosis of CAPD, Bamiou et al. devised a testing battery that included baseline audiometric tests, behavioral central auditory tests, and electrophysiological tests [2]. As neuroimage findings in CAPD have not been described, neither a structural nor a functional neuroimaging method was included in the testing battery, despite being commonly recommended as a part of the diagnostic processes. Journal of the Neurological Sciences 277 (2009) 176–180 ⁎ Corresponding authors. Lee is to be contacted at Department of Neurology, Seoul National University Hospital, 28 Yeongeon-Dong, Jongno-Gu, Seoul,110-744, Republic of Korea. Tel.: +82 2 2072 2985; fax: +82 2 3672 7553. Cho, Neuroscience Research Institute, Gachon Medical School, 1198 Kuwol-dong, Namdong-gu, Incheon, 405-760, Republic of Korea. Tel.: +82 32 460 2600; fax: +82 32 460 8230. E-mail addresses: kminlee@snu.ac.kr (K.M. Lee), zcho@gachon.ac.kr (Z.H. Cho). 0022-510X/$ – see front matter © 2008 Elsevier B.V. All rights reserved. doi:10.1016/j.jns.2008.10.020 Contents lists available at ScienceDirect Journal of the Neurological Sciences journal homepage: www.elsevier.com/locate/jns