A case of musical anhedonia due to right putaminal hemorrhage: a disconnection syndrome between the auditory cortex and insula

Abstract

A 63-year-old, right-handed professional chorus conductor developed right putaminal hemorrhage, and became unable to experience emotion while listening to music. Two years later, neurological examination revealed slight left hemiparesis. Neuromusicological assessments revealed impaired judgment of "musical sense," and the inability to discriminate the sound of chords in pure intervals from those in equal temperament. Brain MRI and tractography identified the old hemorrhagic lesion in the right putamen and impaired fiber connectivity between the right insula and superior temporal lobe. These findings suggest that musical anhedonia might be caused by a disconnection between the insula and auditory cortex.

Musical anhedonia and rewards of music listening: current advances and a proposed model

“…Despite a large population of brain‐damaged patients, only a single patient presented with a possible case of musical anhedonia. This individual had damage to the right hemisphere putamen and internal capsule, which is consistent with damage found in a prior case study …”

“…That is, a lack of pleasure in response to music, if due to a perceptual deficit, such as hearing loss or congenital amusia, would not be considered musical anhedonia. Neuropsychological studies have illustrated a double dissociation between musical reward and music perception; for example, case studies have identified individuals with severe deficits in music perception who still have rewarding responses to music, and case studies of patients with musical anhedonia illustrate preserved musical perceptual abilities …”

“…All images in radiological convention (right hemisphere on the left side of the page). Reproduced from Satoh et al . with permission from the publisher (Taylor & Francis Ltd).…”

“…Neuropsychological studies have illustrated a double dissociation between musical reward and music perception; for example, case studies have identified individuals with severe deficits in music perception who still have rewarding responses to music, 51 and case studies of patients with musical anhedonia illustrate preserved musical perceptual abilities. 46,52 In early cases of acquired musical anhedonia, the criterion for classification as musically anhedonic was simply self-report: patients reported a loss of musical pleasure following brain damage. For musical anhedonia without brain damage, the standard measure is currently the Barcelona Musical Reward Questionnaire (BMRQ).…”

“…A recent group-level study investigated the connectivity between the STG and NAcc, via the OFC, and how this connectivity varied as a function of individual differences in musical reward. 60 The authors identified a relationship between musical 61 Case Insula/amygdala LH Satoh et al 46 Case Temporoparietal, frontal RH Hirel et al 62 Case Superior temporal gyrus RH Satoh et al 52 Case Putamen RH Belfi et al 50 Group n/a n/a reward, as measured by the BMRQ, and connectivity between the STG and OFC, in a tract that likely passes through the aIns. This relationship was observed only in the right hemisphere-individuals with musical anhedonia showed higher levels of axial diffusivity in this pathway.…”