one of whom could sing with words and the other without words;^24 a right-handed man
with largely expressive aphasia following left hemispherectomy who could sing familiar
songs with some errors in articulation but with little hesitation;^25 and a woman with
transcortical aphasia (her verbal expression was limited to a few recurrent phrases, such as
‘Hi, Daddy’, but she had compulsively preserved speech repetition with echolalia) who
could sing both old and newly taught songs.^26 Of 24 patients with Broca’s aphasia and
severely restricted speech output, 21 could sing (6 excellently), some sang only without
words, some sang with paraphasic errors, and some needed help to get started.^27 A musi-
cally naïve patient with transcortical aphasia had hyperprosodic speech, whistled much of
the time (including responses to questions), and listened to music much more often than
before his illness.^28
A professional pianist with Wernicke’s aphasia, including alexia and agraphia for lan-
guage, continued to play publicly; he could play unfamiliar melodies sung to him; repro-
duce heard chords; recognize dynamics, instruments, and intentional errors; and read a
score nearly correctly.^29 A music professor with aphasia that included impaired speech
comprehension and severe agraphia continued to write music.^30 The composer Shebalin
developed Wernicke’s aphasia with alexia and agraphia yet continued composing pieces
‘which other musicians considered to be up to standard’, including songs, quartets,
choruses, and a symphony.^31 A conductor with global aphasia and ideomotor apraxia contin-
ued to conduct his orchestra.^32 A blind organist and composer who had written and read
music in Braille developed Wernicke’s aphasia and could no longer read or write language
in Braille; yet he continued to read and write music in Braille.^33
Cases of amusia plus aphasia are similarly diverse. A patient with anomia heard music as
dissonant and voices, including his own, as too high pitched; he could neither sing nor
reproduce rhythmic patterns.^34 Following surgery for a right frontal glioma, an accordionist
had left hemiparesis and mild aphasia. Thereafter he sang ‘wrong’ and could no longer
play his instrument (although he held it properly); he could correctly sing notes sung to
him, but hearing them played on his accordion, he sang them a fourth too high or too low,
and he could not imitate rhythm unless it was bound to a melody.^35 A violinist with absolute
pitch had a stroke with right hemiparesis and Wernicke’s aphasia, after which he had diffi-
culty recognizing intervals, pitches, and rhythmic patterns; imitating heard rhythm; singing
a melody previously unknown to him; and writing music spontaneously or to dictation.^36
A man with probable Broca’s aphasia was unable to identify popular songs or to sing
melodies, but he could sing single tones and sequences without rhythm; rhythm recogni-
tion and production were completely lost whether presented visually, aurally, or tactily.^37 A
musician with primary progressive aphasia, unable any longer to read music, could impro-
vise but did so repetitively and without completion; he could not write or copy music or
reproduce rhythm, but he could reproduce fragments of melodies with a sense of meter.^38
A woman with computerized tomographic evidence of right perisylvian atrophy developed
aprosodic speech and could not recognize the prosody (e.g. sad, glad, mad) of others; she
could no longer sing even single notes or identify melodies, although she could tell which
of two notes was higher, and she could read and write music.^39
Maurice Ravel had progressive aphasia with alexia, agraphia, and ideomotor apraxia;
‘musical thinking’ was said to be intact—he recognized melodies and errors of rhythm and184 Zat-Ch12.qxd 6/6/03 3:43 AM Page 184