title: A case of expressive-vocal amusia in a right-handed patient with left hemispheric cerebral infarction.
abstract: A 53-year-old right-handed woman had an extensive lesion in the left hemisphere due to an infarction caused by vasospasm secondary to subarachnoid bleeding. She exhibited persistent expressive-vocal amusia with no symptoms of aphasia. Evaluation of the patient's musical competence using the Montreal Battery for Evaluation of Amusia, rhythm reproduction tests, acoustic analysis of pitch upon singing familiar music, Japanese standard language tests, and other detailed clinical examinations revealed that her amusia was more dominantly related to pitch production. The intactness of her speech provided strong evidence that the right hemisphere played a major role in her linguistic processing. Data from functional magnetic resonance imaging while she was singing a familiar song, a scale, and reciting lyrics indicated that perilesional residual activation in the left hemisphere was associated with poor pitch production, while right hemispheric activation was involved in linguistic processing. The localization of infarction more anterior to the left Sylvian fissure might be related to the dominant deficits in expressive aspects of the singing of the patient. Compromised motor programming producing a single tone may have made a major contribution to her poor singing. Imperfect auditory feedback due to borderline perceptual ability or improper audio-motor associations might also have played a role.
authors.affiliation: Division of Music Therapy, Department of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto Shingu-cho, Tatsuno City 679-5165, Japan. Electronic address: uetsuki107@gmail.com.
authors.forename: Shizuka
authors.initials: S
authors.lastname: Uetsuki
authors.affiliation: Biomechanics and Motor Control Laboratory, Graduate School of Medicine Osaka University, 1-17, Machikaneyama, Toyonaka, Osaka Prefecture 560-0043, Japan. Electronic address: k.hiroshi0929@gmail.com.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kinoshita
authors.affiliation: Department of Neurology, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto Shingu-cho, Tatsuno City 679-5165, Japan. Electronic address: r_takahashi@hwc.or.jp.
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Takahashi
authors.affiliation: Department of Human Media Systems, Graduate School of Information Systems, University of Electro-Communications, 1-5-1 Chofugaoka, Chofu, Tokyo, Japan. Electronic address: satoshi.obata@gmail.com.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Obata
authors.affiliation: Department of Psychiatry, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto Shingu-cho, Tatsuno City 679-5165, Japan. Electronic address: t.kakigi@gmail.com.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kakigi
authors.affiliation: Department of Rehabilitation, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto Shingu-cho, Tatsuno City 679-5165, Japan. Electronic address: st_hp@hwc.or.jp.
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Wada
authors.affiliation: Department of Neurology, Hyogo Prefectural Rehabilitation Hospital at Nishi-Harima, 1-7-1 Kouto Shingu-cho, Tatsuno City 679-5165, Japan. Electronic address: k_yokoyama@hwc.or.jp.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Yokoyama
mesh_terms: D001037:Aphasia / Q000503:physiopathology* / Q000523:psychology; D001931:Brain Mapping; D002544:Cerebral Infarction / Q000503:physiopathology*; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009146:Music; D009460:Neurologic Examination; D010468:Perceptual Disorders / Q000503:physiopathology* / Q000523:psychology; D010897:Pitch Discrimination / Q000502:physiology*; D063346:Singing / Q000502:physiology*; D013018:Sound Spectrography; D013060:Speech / Q000502:physiology
keywords: Acquired amusia; Intact speech; Left hemisphere lesion; Subarachnoid bleeding; fMRI