Characteristics of auditory agnosia in a child with severe traumatic brain injury: A case report Nina Hattiangadi, a, * Joseph P. Pillion, b Beth Slomine, a James Christensen, c Melissa K. Trovato, c and Lynn J. Speedie a a Department of Neuropsychology, Kennedy Krieger Institute, Johns Hopkins School of Medicine, USA b Department of Audiology, Kennedy Krieger Institute, Johns Hopkins School of Medicine, USA c Department of Physical Medicine and Rehabilitation, Kennedy Krieger Institute, Johns Hopkins School of Medicine, USA Accepted 11 May 2004 Available online 11 June 2004 Abstract We present a case that is unusual in many respects from other documented incidences of auditory agnosia, including the mechanism of injury, age of the individual, and location of neurological insult. The clinical presentation is one of disturbance in the perception of spoken language, music, pitch, emotional prosody, and temporal auditory processing in the absence of significant deficits in the comprehension of written language, expressive language production, or peripheral auditory function. Furthermore, the patient demonstrates relatively preserved function in other aspects of audition such as sound localization, voice recognition, and perception of animal noises and environmental sounds. This case study demonstrates that auditory agnosia is possible following traumatic brain injury in a child, and illustrates the necessity of assessment with a wide variety of auditory stimuli to fully char- acterize auditory agnosia in a single individual. Ó 2004 Elsevier Inc. All rights reserved. Keywords: Auditory agnosia; Auditory perception; Auditory brain stem response; Verbal comprehension; Language processing; Complex sound processing; Pure word deafness; Temporal processing; Traumatic brain injury; Pediatric 1. Introduction Early accounts of pure word deafness were often di- agnosed solely based on the presence of impairments in auditory comprehension, repetition, and writing to dic- tation in the presence of spared pure tone audiometric findings. In most cases with the presentation of pure word deafness, however, exposure to a wider range of auditory stimuli has revealed additional impairments in other aspects of auditory processing. In a recent review of 63 cases of ‘‘pure word deafness’’ subjects, only five case studies reported normal nonverbal sound process- ing, with all others presenting with impairments in processing of music and/or environmental sounds (Pinard, Chertkow, Black, & Peretz, 2002). Auditory agnosia refers to a more generalized impairment in the recognition of sounds. While auditory agnosia is far from a new concept (Liepmann, 2001), the availability of a greater variety of auditory stimuli used in assess- ment of agnosia has led to greater appreciation of the complexity of the disorder. For example, several case studies describe a single individual who has demon- strated different agnosias at different times (Mendez & Geehan, 1988; Motomura, Yamadori, Mori, & Tamaru, 1986). These studies typically describe a patient pre- senting with an initial onset of ‘‘cortical deafness’’ but subsequently demonstrating gradual recovery for dif- ferent auditory stimuli. In the Mendez and Geehan case study, for example, the initial presentation of cortical deafness was followed by inconsistent reactions to sound. Subsequently, improved pure tone thresholds, recognition of environmental noises, music recognition, and finally speech recognition returned in that order * Corresponding author. Present address: Department of Psychol- ogy, The ChildrenÕs Hospital of Philadelphia, 3405 Civic Center Boulevard, Philadelphia, PA 19104, USA. Fax: 1-215-590-5637. E-mail address: hattiangadi@email.chop.edu (N. Hattiangadi). 0093-934X/$ - see front matter Ó 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.bandl.2004.05.003 Brain and Language 92 (2005) 12–25 www.elsevier.com/locate/b&l