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Gustatory agnosia

From the John B. Pierce Laboratory (Dr. Small), New Haven, CT; Department of Surgery (Dr. Small), Yale University School of Medicine, New Haven, CT; and Department of Neurology and Neurosurgery (Drs. N. Bernasconi, A. Bernasconi, Sziklas, and Jones-Gotman), Montreal Neurological Institute and McGill University, Montreal, Quebec, Canada.

Address correspondence and reprint requests to Dr. Dana Small, Yale University School of Medicine and The John B. Pierce Laboratory, 290 Congress Avenue, New Haven, CT 06519; e-mail: dsmall{at}jbpierce.org

Objective: To report the assessment of a patient exhibiting gustatory agnosia.

Methods: Preoperative and postoperative neuropsychological, neuroimaging, and chemosensory evaluations were performed in a 39-year-old woman undergoing surgical treatment for intractable epilepsy.

Results: Preoperative MRIs showed bilateral (right > left) atrophy in the medial temporal lobes and complete atrophy of the left insula. Evaluation of gustatory function revealed normal suprathreshold intensity estimation, affective evaluation, and detection thresholds but elevated recognition thresholds. A functional neuroimaging study showed activation to stimulation of aversive taste in the left amygdala. Surgical treatment entailed resection from the left medial temporal lobe that included the region of amygdala that had responded to taste. Postoperatively, detection, naming, and intensity estimation for taste remained normal, but the patient was unable to recognize different tastes (sweet, sour, salty, and bitter). A second evaluation 2.5 years after her surgery revealed no change in taste ability.

Conclusion: The anteromedial temporal lobe has an important role in recognizing taste quality.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the January 25 issue to find the title link for this article.

Supported by grant MT144991 from the Medical Research Council of Canada (M.J-G.) and by grant R03 DC006169–01 (D.M.S.) from the National Institute of Deafness and Other Communication Disorders.

Received March 17, 2004. Accepted in final form September 7, 2004.

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