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Introduction
Disorders of audition stand at a crossroads between neurology, audiology, psychiatry and ENT. It is not uncommon for patients to ‘fall between the cracks’ of the referral pathway, and to become increasingly frustrated when specialties cannot decide who is responsible for them. The aim of this ‘How to understand it’ article is to demystify central auditory disorders for neurologists, and to show that they can be assessed like any other neurological symptom, based on a consideration of the anatomy and physiology of the auditory pathway. To illustrate this we describe the case history of a patient who had lost the ability to recognise and appreciate music who presented to an audiology clinician (DMB), who then sought neurology support (TEC, TDG). We elucidated the nature of the deficit in the analysis of sound patterns using psychophysics, but the deficits could have been predicted by a consideration of the anatomy and physiology of the auditory system.
Case history
The patient was a 48-year-old, right-handed salesman who was a keen listener to popular music. He had no previous symptoms relating to environmental sound or speech perception.
He suffered two low-speed road traffic accidents in a single journey on the way to work. The first was nose-to-tail, as he failed to see the car in front stop in traffic, and the second was nose-to-nose with a parked car. After the second incident, he pulled over and called an ambulance, as he felt ‘disorientated’. The ambulance crew found him to be confused and complaining of headache and nausea, so brought him to hospital. Initial physical examination showed no injuries but his blood pressure was 230/120 mm Hg. Neurological examination identified a left upper motor neurone facial palsy with preserved limb power, left-sided sensory and visual neglect, left-sided hyper-reflexia and left extensor plantar response. Immediate unenhanced CT of the head …
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