Mutism and auditory agnosia due to bilateral insular damage--role of the insula in human communication

Neuropsychologia. 1995 Mar;33(3):327-39. doi: 10.1016/0028-3932(94)00108-2.


We report a case of transient mutism and persistent auditory agnosia due to two successive ischemic infarcts mainly involving the insular cortex on both hemispheres. During the 'mutic' period, which lasted about 1 month, the patient did not respond to any auditory stimuli and made no effort to communicate. On follow-up examinations, language competences had re-appeared almost intact, but a massive auditory agnosia for non-verbal sounds was observed. From close inspection of lesion site, as determined with brain resonance imaging, and from a study of auditory evoked potentials, it is concluded that bilateral insular damage was crucial to both expressive and receptive components of the syndrome. The role of the insula in verbal and non-verbal communication is discussed in the light of anatomical descriptions of the pattern of connectivity of the insular cortex.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Agnosia / etiology*
  • Audiometry, Pure-Tone
  • Auditory Perception*
  • Brain Ischemia / complications*
  • Brain Ischemia / diagnostic imaging
  • Brain Ischemia / physiopathology*
  • Brain Mapping
  • Corpus Striatum / diagnostic imaging
  • Corpus Striatum / physiopathology*
  • Evoked Potentials, Auditory
  • Female
  • Functional Laterality
  • Humans
  • Language Disorders / diagnosis
  • Language Disorders / etiology
  • Magnetic Resonance Imaging
  • Mutism / etiology*
  • Neuropsychological Tests
  • Radiography
  • Temporal Lobe / diagnostic imaging
  • Temporal Lobe / physiopathology*