Contrasting spatial hearing deficits in hemianopia and spatial neglect.

Spatial hearing deficits have been described in widely differing pathologies, including bilateral temporal or unilateral parietal lesions, hemispherectomy, spatial neglect and right-sided cortical lesions without neglect. However, the topography of spatial hearing deficits after cortical lesions is only poorly understood, unlike that of vision and touch. We investigated the auditory subjective straight ahead (SSA) with a new technique of binaural sound source simulation using broad-band single pulses which were filtered with head-related transfer functions and delivered with a 5 degree resolution over headphones in front space. Normal subjects showed quite accurate judgments of the SSA, with a small but significant shift to the left of centre (-1.7 degrees) in the horizontal plane. Hemineglect without a scotoma, produced a large ipsilesional deviation of the auditory SSA (+22 degrees), while two hemianopic subjects, both without neglect, showed the opposite deviation of their perceived auditory SSA towards their contralesional, blind hemifield (+10 vs -28 degrees). Two control patients with unilateral lesions, both without neglect and without hemianopia, produced normal judgments of their auditory SSA (-3.0 degrees, +3.8 degrees). These results suggest at least two contrasting influences on directional spatial hearing after unilateral cortical lesions: hemianopia vs hemispatial neglect. The results are interpreted in favour of multisensory convergence of visual and auditory information in directional spatial hearing.