INTACT ABSOLUTE PITCH ABILITY AFTER LEFT

TEMPORAL LOBECTOMY
Robert J. Zatorre
(Montreal Neurological Institute and Hospital, McGill University)

Absolute pitch (AP) is generally defined as the ability to identify by note

name the pitch of a large number of musical tones, and to produce the pitch of a
note without making use of a reference tone. Considerable research has been
carried out with the relatively rare individuals who possess AP, especially
because they seem to be an exception to Miller's (1956) formulation about the
limitation of absolute identification along a stimulus continuum (for a recent
review of the field see Ward and Burns, 1982).
Despite the large body of research on AP, there has been almost no work, to
date, on its neural basis. Many case reports have appeared in the literature
describing the effects of brain lesions on musicians (for summaries and discus-
sion of this research see Benton, 1977; Marin, 1982; Zatorre, 1984), but only one,
to my knowledge, has reported on the effects of such lesions on AP ability. Wert-
heim and Botez (1961) reported a case of a professional violinist with AP who
suffered a left-hemisphere stroke. This resulted in right hemiparesis and a
mixed, predominantly receptive dysphasia which was comparatively mild. The
patient performed poorly on a number of musical tasks, but the most interesting
disturbance was observed in pitch naming and production. He correctly named
only 2 out of 7 tones presented to him, but many of the errors were a perfect
fourth higher than the played tone. He was also unable to sing the correct pitch
when given the corresponding note name, but in this case he did not show a
consistent transposition of pitch. It was presumed that premorbidly he would
have performed such tasks very well.
Although the study of Wertheim and Botez is of considerable interest, many
questions remain about AP and cerebral function. In particular, in that report
the locus and extent of the subject's lesion was unknown, and could only be
estimated from his neurological deficits. Also, the AP testing was relatively
limited (e.g., apparently only 7 fones were presented for identification). How-
ever, this case report does raise the important question of whether certain left-
hemisphere lesions may produce disturbances in AP, and if so, what the nature
of that impairment may be. The present report presents the results of two
experiments performed on a young man who possessed AP, and who underwent
left temporal lobectomy for relief of epileptic seizures. This case therefore per-
mits another approach to this issue, and may complement both the previous

Cortex, (1989) 25, 567-580

568 Robert J. Zatorre

report as well as other studies that may be carried out in the future.
It should be pointed out that, in general, the study of single cases is often
fraught with difficulties which, if not carefully considered, can lead to erroneous
conclusions (see Zatorre, 1984, for further discussion). It is clear, for example,
that selecting for study individuals with certain skills will result in a biased
sample, not necessarily representative of a population. Thus, case studies of
musicians with brain damage do not always permit simple generalizations to be
made; conclusions drawn may not be valid for other individual cases, or for
groups. It is also difficult to reach conclusions regarding the function of partic-
ular cerebral structures without control groups of subjects, which many case
studies have lacked in the past. Finally, it is often difficult to make comparisons
among different cases because the level of premorbid musical sophistication
may be unknown or undocumented, and because the tasks used by various
investigators have not been uniform.
Although such studies are not necessarily the best paradigm for addressing
neuropsychological issues with respect to processing of musical stimuli, if we are
to study certain exceptional abilities, then individual case studies are the only
alternative. In the case to be described in this report there is the added advantage
of being able to study an individual both before and after brain surgery, thereby
permitting direct comparison of the effects of the excision. In the case of surgery
for epilepsy, both the site and extent of the lesion are well documented. More-
over, the effects of such surgery on cognitive function have been studied for
many years (e.g., Milner, 1978), thereby permitting comparison of the results of
an individual to the results oflarge groups of subjects with similar lesions on at
least some tasks.
The approach taken in the present report is to examine different musical
skills using paradigms and procedures that have previously been applied in
cognitive and psychophysical studies of musical perception. By testing under
controlled conditions and comparing the results to studies with neurologically
intact subjects, it was hoped that some insight could be gained into the cerebral
mechanisms underlying AP. Two types of abilities were investigated: identifi-
cation of single piano tones, and short-term retention of the names of three-note
groups with verbal interference. Each of these experiments is described in detail
following the case report information.

CASE REPORT

History

Da. H. was 17 years old at the time this study was begun. His musical background is as
follows. He had studied piano for many years, and at some point came to realize that,
without effort, he could identify by name any piano note that was played to him. He
reported that he did not have a similar skill for sounds made by other instruments. In
addition to piano lessons, he had also studied music theory and harmony, largely by
correspondence.
His medical history is as follows. He was the product of a normal gestation, but at birth
labor was difficult. At age 18 months he had his first generalized seizure, and another
episode occurred at age 3 years, when he had generalized convulsions lasting two and a
 Musical abilities and left temporal lobectomy 569

half hours. At age 6 he developed partial complex seizures during which he would drop
things held in the right hand, stare and be unresponsive. Postictally he was usually
dysphasic for several hours. The seizures continued over the years and were often preci-
pitated by physical exertion or stress; they occurred with a frequency of 3 or 4 a week. He
was prescribed Tegretol for seizure relief, but this proved ineffective in reducing the
seizure tendency, and he was admitted to the Montreal Neurological Hospital for inves-
tigation and surgery.

Neurosurgical Procedure
The electroencephalographic findings (performed with surface and sphenoidal elec-
trodes) indicated an active seizure focus in the left temporal lobe. In March of 1986 he
underwent an anterior left temporal lobectomy including the amygdala, uncus and 2 em of
the hippocampus and parahippocampal gyrus, but sparing Heschl's gyri. According to
Corsi's (1972) criteria, this degree of hippocampal excision is extensive, although it is not
a radical hippocampal removal. On the cortical surface the resection measured 4.5 cm
along the Sylvian fissure, and 5 cm along the third temporal gyrus. The findings at surgery
included marked induration of the temporal cortex and amygdala. Electrocorticography
prior to resection indicated active epileptiform activity from the temporal cortex. Fol-
lowing the excision there was still some active residual spiking behind the removal margin.
Neuropathological analysis of the excised tissue revealed mild to moderate neuronal loss
and gliosis.
He recovered quickly from the acute effects of the intervention, and had no posto-
perative complications. As of the time of follow-up examination (one year after surgery),
his progress had been satisfactory in that he had had no further clinically evident seizures,
and had been able to enroll in university.

Neuropsychological Examination
An extensive neuropsychological investigation was carried out preoperatively, two
weeks postoperatively and in follow-up one year later. He was found to be strongly
right-handed, as were both his parents. The fused rhymed dichotic words test (Wexler and
Halwes, 1983) showed a clear right-ear advantage, consistent with speech representation
in the left cerebral hemisphere (Zatorre, 1989 a). Standard intelligence and memory tests
were all generally performed well. On the Wechsler Adult Intelligence Scale-Revised his
preoperative IQ scores were in the average range (Verbal IQ 109, Performance IQ 102,
Full-Scale IQ 106). It is interesting that when this test was repeated postoperatively a trend
for higher Performance IQ emerged, and by the time of the follow-up examination the
discrepancy was even larger (Verbal I Q 106, Performance IQ 126, Full-Scale I Q 115).
Although the Performance scale is known to be more susceptible to practice effects
(Wechsler, 1981), the 20-point lower Verbal IQ in follow-up is significant in that only 4.8%
of persons at this FSIQ level in the WAIS-R standardization sample obtained a discre-
pancy of 20 or more points in this direction (Matarazzo and Herman, 1985). This result
may therefore be indicative of some mild verbal processing deficits, which would be
consistent with a left-hemisphere lesion.
Preoperatively, few deficits were uncovered by testing except for mild difficulty with
naming objects and somewhat low word fluency output. No significant deficits were
uncovered in immediate or delayed recall of verbal passages or of the Rey Complex Figure
either pre or postoperatively. In follow-up, Corsi's (1972) sequence-learning task, known
to be sensitive to hippocampal damage, was administered, and the results did show a
selective deficit. On this task the subject is given a supraspan sequence of either digits or a
block pattern to repeat. A set of 24 sequences is given, but unknown to the subject, every
third trial contains the same sequence. Corsi has shown that learning of this repeating
sequence is impaired following temporal lobectomy but only if there is significant damage
to the hippocampus, with left-sided lesions affecting verbal (digit) learning, and right-
sided lesions affecting spatial (block pattern) learning. Oa.H. showed significant learning
570 Robert J. Zatorre

Test 1 100
Test 1
100
90 Pre·Op 1 Oa. H. 90 Posl·Op

80 80
70 70
60 60
50 50
40 40
(/) 30 30
(/)
Q)
(/) 20
Q)
(/)
20
c: c:
0 10 0 10
a.
(/)
a.
Q) 0
(/)
Q)
0
II: ';-16 -12 -8 -4 0 4 8 12 ;'16 II: ';-16 -12 -8 -4 0 4 8 12 ;'16
100 100
"E "E
Q)
90 Pre·Op 2 Q) 90 Follow·Up
~ ~
Q) 80 Q) 80
c.. c..
70 70
60 60
50 50
40 40
30 30
20 20
10 10
o~~~~~~~~~~~~~~ O~~~~~"~~~~~~~~T
.; -16 -12 -8 -4 0 4 8 .. -16 -12 -8 -4 0 4 8 12 ;'16
Semitones From Target Semitones From Target

Fig. 1 - Percent responses in absolute pitch naming task expressed as deviation in semitones from
target. Shown are data from two preoperative, one postoperative, and one follow-up session. On the
abscissa zero represent correct identification, positive numbers indicate responses higher (sharp) than
the target, negative numbers indicate lower (flat) responses. Test 1 consisted of the twelve notes of the
chromatic scale chosen across octaves so that no chroma was repeated within a single octave.

of the block pattern, and was aware that the same sequence was recurring. With the digit
sequences, however, he did not show a consistent improvement over trials for the recur-
ring pattern, and furthermore, did not notice that the sequence was repeating. Da.H-'s
performance on this test is therefore consistent with the site of the lesion.
During one of the preoperative testing sessions Da.H. had a seizure during which he
was unresponsive, and was unable to name objects or follow instructions. However, when
a song was hummed to him he was able to hum the rhythm back in a monotone voice. He
was also able to imitate rhytmic patterns by tapping. Two hours after the seizure there was
residual dysphasia: he had difficulty counting backwards and naming common objects. At
this time he could sing songs correctly but without words. He could also imitate single
notes or patterns of three notes very quickly and accurately by whistling them. Repetition
of rhythms was also excellent.
In order to assess Da.H-'s musical skills in a systematic fashion, he was tested with
several different tests on two separate occasions before he underwent surgery, as well as
one week and one year following the intervention. These are detailed below.

EXPERIMENT 1: PITCH IDENTIFICATION

In this task the subject simply hears a musical tone and must write down the
correct symbol corresponding to its pitch, in musical notation, using no other
reference. Several studies (Lockhead and Byrd, 1983; Klein, Coles and Donchin,
1984; Zatorre and Beckett, 1989) have examined the accuracy of pitch naming
 Musical abilities and left temporal lobectomy 571

Test 2 Test 2
100 100
Pre'Op 1 Oa. H. Post Op
90 90
ao 80
70 70
60 60
50 50
40 40

*
30 30
w
Ql 20
w 20

~~~~~J .~
c: 10 c: 10
0
c.
W 0 8.
w O~~~~~~~~~~~~~~
Ql
c:: 100
-a a
';-16 -12 -4 0 4 12 ~16 £. 4
100 ';-16 -12
-8 -4 12 ~16 a a
c:
Ql 90 Pre·Op 2 ~ 90 Follow·Up
()
a; 80 ~ ao
Q. 70
70 Q.

60 60
50 50
40 40
30 30
20 20
10 10
o ~ O+,~~~~~~~~~~~~,
';-16 -12 -a -4 0 4 a 12 ~16 ';-16 -12 -8 -4 a 4 a 12 ~16
Semitones From Target Semitones From Target

Fig. 2 - Same as Figure 1 for absolute pitch naming Test 2, consisting of only the notes C and G
repeated within each octave.

among self-proclaimed possessors of AP. It is generally found that although roost

such subjects are indeed very accurate, they do show some consistent errors,
particuarly at the octaves. Similar tasks were prepared for Da.H to examine his
AP ability directly, and to assess any changes following his surgery.

Procedure
Three pitch identification tests were administered, consisting of isolated piano tones
played on a tuned Mason and Hamlin grand piano (for further details of stimulus con-
struction see Zatorre and Beckett, 1989, from which these tests were taken). Piano tones
were chosen despite the multiplicity of cues they provide because Da.H. found piano tones
easiest to identify. In test 1 twelve tones were chosen from the range two octaves below
middle C to G two and a half octaves above middle C, all separated by an interval of a
perfect fourth. Thus, no tone chroma was repeated within anyone octave. The 12 notes in
this test were presented four times each in random order, for a total of 48 items. In test 2
the same range of notes was used, but only the notes C and G appeared, six times each,
always in different octaves, for a total of 36 notes. Test 2 was expected to produce a greater
number of octave errors as compared to test 1 (Ward and Bums, 1982). Test 3 consisted of
the 12 notes ofthe chromatic scale between middle C and the C an octave above, including
this latter note, for a total of 13 notes, repeated four times each.
Both the intensity and duration of each note were varied in a non-systematic fashion in
an attempt to avoid extraneous cues. A gap of approximately 10 sec was left between notes
for response. Stimuli were recorded onto a cassette tape, and played back in free-field
listening. Da.H. was given music paper and instructed to write the note he heard on each
trial in musical notation. No feedback was given, and he was not allowed to change a
response after it had been written down.
572 Robert J. Zatorre

Test 3 Test 3
100 100
Pre·Op 1 Oa. H. Post·Op
90 90
80 80
70 70
60 60
50 50
40 40
30 30
(/) (/)
Q)
20 Q) 20
(/) (/)
c: 10 c: 10
8.
(/) 0 _I t..,--r-...... ...,.....--.-.-~-. T
0
c.
(/) 0
Q)
",-16 -12 -8 -4 0 4 8 12 ~16
Q) ",-16 - 12 -8 -4 0 4 8 12 ~ 16
II: II:
100 100
c:
Q) 90 Pre'Op 2
c:
Q)
90 Fottow·Up
0
iii 80
0
iii 80 J
Q. Q.
70 70

1
60 60
50

~1
40
30
40
30
20 20
IOJ
o I I
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" I "
-8
.
-4
,
0
,
4 8
,
12
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~16
10
0
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II
0 4 8 12 ~16
Semitones From Target Semitones From Target

Fig. 3 - Same as Figure 1 for absolute pitch naming Test 3, consisting ofthe 12 notes ofthe chromatic
scale chosen from within one octave.

Results

The results for the pitch naming tests are shown in Figures 1, 2and 3 which
plot the distribution of error scores in semitones from the intended target.
Preoperatively, Da.H. was generally able to give a correct note name, but on the
first testing session his responses tended to be sharp by one semitone, and on the
second session thefesponses tended to be flat by a semitone. This occurred for all
three tests. As expected, test 2 tended to produce more octave errors, and these
errors also were sharp on the first session and flat on the other (Figure 2: note that
in session Pre-Op 1 there are many errors at 13 semitones away from the target,
and that in session Pre-Op 2 there are many errors at 11 semitones from the
target),
The most interesting results was obtained one week postoperatively, when he
actually improved, so that for the first time the majority of responses were
exactly correct on all three tests. One year later, the excellent pitch naming
performance was replicated.
His performance postoperatively and in follow-up was comparable to that of
the normal musicians with absolute pitch tested by Zatorre and Beckett (1989)
under identical conditions, both in terms of the number of errors and their
distribution.
 Musical abilities and left temporal lobectomy 573

Discussion
The results in this patient clearly indicate that AP naming ability does not
depend on mechanisms in the left anterior or medial temporal region. It is
particularly striking that performance improved following surgery to levels
typical of subjects who proclaim AP (Lockhead and Byrd, 1981; Klein, Coles and
Donchin, 1984). The error pattern included clusters of errors at the octave,
which is also a commonly observed effect among AP possessors; it is interesting
that even these errors followed the tendency to be sharp on the first session and
flat on the second. Two questions arise from these findings: why were there
fluctuations in perceived pitch during the preoperative assessments, and what
may account for the improvement observed postoperatively?
The preoperative fluctuations may be due to a number of factors. Several
investigators have reported changes in AP with such physiological variables as
menstrual cycle and age (Vernon, 1977; Wynn, 1971, 1972). There are also
indications (Tanzman, personal communication; Zatorre, unpublished observa-
tions) that some subjects with AP experience an alteration in their pitch per-
ception when taking Tegretol, an anti-seizure medication. The mechanism
underlying such effects is unknown, but the fluctuations in Da.H.'s performance
may well have been related to changes in drug levels, since during the two
preoperative assessments his medications were being reduced in order to record
electroencephalographic abnormalities. Furthermore, interictal electrographic
abnormalities and/or seizure activity itself may have been responsible for the
observed variations, since he had had some seizures around the time of testing.
The patient himself did not seem aware of the fluctuations, except to complain
that a piano he had played while in the hospital had been tuned flat by a
semitone (whereas in fact it was in tune).
As for the improved postoperative performance, the most attractive expla-
nation is that with the removal of the epileptogenic focus, there was less inter-
ference with overall cerebral function, permitting closer to optimal performance.
Certainly the results would suggest that left temporal-lobe structures do not play
any significant role in AP naming. The fact that performance continues to be
good after one year is consistent with this interpretation. Since his drug regime
was stabilized after surgery, fluctuations would not be expected if indeed the
medication caused this effect.
One other potential source of improvement is a simple practice effect. This
factor may well have played some role, particularly as Da.H. became familiar
with the testing situation and the timbre of the instrument used. However, it
cannot account for the large improvement observed after surgery. Against this
interpretation is the fact that there was little if any improvement between the
first and second sessions. Also, it is most unlikely that Da.H. would have been
able to remember any significant part of the sequence of random tones, as there
were a total of 135 tones in the three tests, and no feedback was ever given. The
fact that performance remained excellent after a year's time in which he was not
exposed to the test nor to the piano on which it was recorded is further evidence
against any important effect of practice.
Another factor that must be assessed is the contribution of relative pitch to
574 Robert J. Zatorre

the task. Having notated one tone correctly, all the other notes in the test could,
in principle, be derived by relative pitch. In fact, the consistent errors in one
direction during the preoperative assessments might suggest that such a strategy
was being used. It is not possible to say that relative pitch played no role in the
task as it was administered. However, several facts suggest it did not playa major
role. First, Da.H. was instructed to listen to each note and judge it in isolation; he
was not permitted to go back and change a note after hearing a later one in the
series (although he did wish to do that on a few occasions). Second, his behavior
was not consistent with relative pitch judgments: he was usually fast in his
responses, and did not seem to need to figure out the interval produced between
one note and the next (he denied the need to do this, as well). Also, the pattern of
errors does not suggest that relative pitch was being used: when be made con-
sistent errors in one direction they did not necessarily occur all together in one
"run" as might be expected were he judging the pitch of each note based on the
previous one.

EXPERIMENT 2: SHORT-TERM RETENTION OF NOTES AND LETTERS

A second question of interest is whether retention of information about
musical tones in working memory might depend on a verbal code. Such a claim
has been made explicitly by Siegel (1974) who found that persons with AP were
able to retain the pitch of a tone over a 15-sec retention interval filled with
irrelevant tones, whereas musicians who did not have AP tended to forget the
tone as the retention interval grew longer. Ifnotes are coded verbally, then verbal
interference (counting) should have a detrimental effect on retention of the
information. It is known from the work of Corsi (1972; see also Milner, 1978)
that left medial-temporal lobe lesions are associated with a faster than normal
decay of information from short-term verbal memory. Therefore, if verbal cod-
ing is used by AP possessors in coding of pitch in short-term memory, significant
deficits would be predicted following a left temporal-lobe excision. On the other
hand, Zatorre and Beckett (1989) reported that musicians with AP recalled
accurately the letter names ofthree tones after verbal interference, but tended to
forget purely verbal information. Deutsch (1970) also suggested that different
mechanisms may exist in non-AP possessors for verbal as opposed to tonal
retention. The results of Da.H. on this task should therefore provide a good test
ofthe degree to which verbal encoding is important in retention of note names by
persons with AP.

Procedure
This experiment assessed the retention of letters or notes during a retention period
filled with an interfering task. It was given on two occasions, once 10 days following his
operation, and again in one year follow-up testing. The procedure was the same as used by
Zatorre and Beckett (1989). In the first test 16 three-note groups of notes, chosen from the
natural scale between middle C and C one octave above, were presented at a rate of about
one note per second. Rising, faling, V and inverted V contours were equally represented.
The verbal test contained 24 consonant trigrams, or three-letter combinations, randomly
chosen from the alphabet, but excluding vowels. The same trigrams originally used by
 Musical abilities and left temporal lobectomy 575

~-""""':'~.':::':"-:":'-,-,-
- - __.-.-.-.. 3 Notes
90 ----....:::..:-.:.:..:.:.:..-:::. ...:-..:...:..:.:.:..-..:-.-.-. NC
----40 a .H

t5 80
....Q)
()
o 70
+-'

55 60
....oQ)
a.. _ 50
Oa.H
40

T
o 3 6 9 12 15 18
Retention Interval (sec)
Fig. 4 - Percent correct recall by Da.H.for consonant trigrams andfor the names ofthree notes as a
function of duration offilled retention interval, in sec.

..................
..... ... ........
90 ......... .................... _._._ ......... ...
..... . -.- ...... _. - .- ...... -. _ . _.... NC

, ,,
..... __ ..0.. .....
+-'
80 ..•• ..... ......

,
0 ... ..... .....
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0 70
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,
,
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.................................................................
'.

40 ,.,.,.,." . ,. :I-OP
T I

o 3 6 9 12 15 18
Retention Interval (sec)

Fig. 5 - Percent correct recall ofconsonant trigrams for case Da.H., along with data on the same task
from Corsi (1972) for patients with left temporal lobectomy including extensive excision of the hippo-
campus, and data from normal control musicians with AP from Zatorre and Beckett (1989); rescored
without respect to order of report.
576 Robert J. Zatorre

Corsi (1972) were used in this task. In the musical memory task the subject listened to
the three notes and immediately named them. After identification he was given a three-
digit number and requested to count backwards for a period of either 9 or 18 sec, which
was determined randomly. Then he was to name the three notes once more. Two practice
examples were given before beginning the test.
In the verbal task the procedure was similar: a trigram was read aloud, and after the
subject repeated it he was given a three-digit number from which to count backwards.
Delays of 3, 6, 9, 12, 15, and 18 sec were used in order to compare the data with that
obtained by Corsi. The order of different conditions was determined randomly. Two
practice items were given before starting. Scoring of both tones and letters was done
without respect to order of report.

Results

The results of this experiment are shown in two figures. Figure 4 plots the
percent correct identification for Da.H. in postoperative testing for letters and
notes as a function of retention interval, along with comparison data on note
retention for normal AP possessors tested under identical conditions (Zatorre
and Beckett, 1989). Figure 5 shows the performance ofDa.H. in the verbal task
in postoperative and in follow-up testing, along with comparison data from
Corsi (1972) for a group often patients with left temporal lobectomy and with an
extensive hippocampal resection similar to that undergone by Da.H. Also shown
in Figure 5 are data for the same verbal task from the group of normal control
musicians with AP tested by Zatorre and Beckett, rescored without regard to
order of report 1•
In the tonal retention task (Figure 4) Da.H. performed well: in postoperative
testing he achieved an average score of 89.5% correct. This compares favorably
with the 93.5% correct recall rate of the normal subjects with AP studied by
Zatorre and Beckett (the difference of 4% between Da.H.'s performance and that
of the normals does not approach conventional levels of significance (p>.25),
and he scored as well or better than six of the eighteen subjects in that group).
There was essentially no forgetting over the 18 sec period. This result was
replicated one year later, when Da.H.'s average performance on this task was
87.5% at both 9 and 18 sec delay.
In marked contrast, his retention of letter trigrams (Figure 5) was poor,
especially at the longest retention interval. In postoperative testing he was at
approximately the same level as controls until 12 sec, but at the end of 18 seconds
of verbal interference he could remember, on average, only 46% of the three
letters presented initially, which is significantly lower (2.4 standard deviations,
p<.008) than the scores obtained by normal control subjects under the same
conditions. In one-year follow-up examination his score was 57% at 18 sec,
which also represents a significant deficit (1.7 standard deviations; p<.04) in
comparison to the normal control subjects2.

I The scores reported here do not take order of report into account, for purposes of comparison with Corsi's data. It
is of interest that if order of report is considered, the discrepancy between Da.H. 's verbal and tonal retention becomes
even greater: at 18 sec delay, for instance, he scored only 35% correct for letter trigrams, but remained at 85% for the
three notes.
 Musical abilities and left temporaiiobectomy 577

Discussion
On the verbal tasks, Da.H. demonstrated the accelerated decay expected
following a left temporal lobectomy that includes a significant hippocampal
resection (Corsi, 1972; Milner, 1978). In contrast, his recall of three note names
was excellent after 18 sec of interference. Note that with zero delay his repetition
of either the letters or the notes was nearly flawless, so that any loss of infor-
mation must be attributable to forgetting and not to deficient initial percep-
tion.
Many differences exist between the verbal and tonal tasks, particularly in the
number of response alternati ves available, and the different number of retention
intervals tested. However, Zatorre and Beckett have clearly shown that these
variables cannot account for the difference in results between the two tasks in
normal AP possessors (using a restricted alphabet of 7 letters does not improve
trigram retention, nor does increased delay lead to a drop in note-rame reten-
tion). Da.H.'s performance on the tonal retention task was entirely comparable
to that reported by Zatorre and Beckett with normal possessors of AP.
It is true that in the tonal retention task a number of cues are available that
should aid in encoding and retaining of the stimuli (including timbral cues,
contour, etc.). It might be argued that because of this the comparison between
letters and tones is invalid. However, the task required only the retention ofthe
verbal code for the notes, since at the end of the delay interval the subject
produced only the note names. The experimental conditions were set up to favor
verbal encoding in order to provide a clear test of the hypothesis that such
encoding is important in the retention of the names of notes. The discrepancy
between the verbal and tonal tasks suggests that retention of tonal information
does not depend exclusively on verbal coding, but rather, Da.H. can probably
make use of a nonverbal coding strategy when necessary. Furthermore, it
appears clear from this experiment that excision of the anterior left temporal
lobe does not affect encoding or retention of tonal material, not even when
explicit verbal identification is required.

GENERAL DISCUSSION

The conclusions that may be drawn from this case study are naturally con-
strained by the inherent limitations of studying a single individual.As discussed
above, however, an exceptional a Jility such as AP does not lend itself easily to
group studies, particularly in the realm of neuropsychology. In any case, the
results are unambiguous insofar as the perceptual abilities tested either im-
proved by comparison to preoperative performance (Experiment 1) or were

• 2 The data in Figure 5 from Corsi's group of subjects with left temporal hippocampal lesions is included for
purposes of comparison. It is not possible to perform a statistical test between Da.H.'s scores and this group because
Corsi's data represent the mean for a group, and no estimate of variability is available. Da.H. would appear to be
slightly better than Corsi's subjects at the shorter delays, but at 18 sec Da.H.'s score is more similar to the patient group
than to the controls. One possible reason for his slightly better than expected performance, at least at the shorter delays
is that Corsi's· subjects had slightly lower IQs than Da.H. (average of 104) and were slightly older (average age of
30.8).
578 Robert J. Zatorre

comparable to results of control musicians with AP (Experiment 2). Thus, we

may safely conclude that the excision of the anterior left temporal lobe in this
patient had no deleterious effect on his AP ability.
Although it is difficult to argue definitively from a negative result, the evi-
dence presented here can be most meaningfully interpreted in terms of disso-
ciations between functions. Certain cognitive functions, particularly those
involving verbal memory, were impaired in this patient, in keeping with the
known effects ofleft medial temporal-lobe damage. Thus, in Experiment 2 recall
of three letters was deficient after 18 seconds of an interpolated verbal task, in
accord with Corsi's (1972) results. This result demonstrates a clear dissociation
between verbally based encoding in working memory and whatever code or
codes were being used to encode the tones.
One speculative interpretation of these results would be that retention of
verbal information depends on the function of structures in the left medial
temporal lobe, whereas retention of tonal information is linked to right tempo-
ral-lobe functioning. According to this account, Da.H. succeeds in recalling
note-names because he has been able to encode the tones both verbally and in
terms of some nonverbal code (such as an auditory image). The lesion causes a
loss of verbal information (as shown by the accelerated forgetting of letter tri-
grams), but tones are retained well because the intact right temporal lobe can
mediate nonverbal encoding and recall. At present there is no direct evidence
that the right temporal lobe is important for whatever type of nonverbal encod-
ing is taking place in this type oftask. However, there is some indirect evidence
for this point of view. It has been reported (Zatorre, 1989 b) that right (but not
left) temporal-lobe lesions in non-AP subjects do lead to poor discrimination of
single tones in a paradigm in which the target tones are separated by tonal
interference (cf. Deutsch, 1970). If the mechanism involved in retaining purely
tonal information by non-AP subjects is similar in some respects to that used by
Da.H., then Da.H.'s good tonal retention could be attributed to his intact right
temporal-lobe function.
Several detailed case reports exist of musicians who suffered extensive left-
hemisphere damage but who, despite marked verbal deficits, showed no signif-
icant deficits in most musical tasks (e.g., Basso and Capitani, 1985; Judd,
Gardner and Geschwind, 1983; Luria, Tsvetkova and Futer, 1965; Signoret, Van
Eeckhout, Poncet and Castaigne, 1987). These observations would be consistent
with the present case insofar as Da.H.'s musical abilities apparently were intact
after surgery. On the other hand, there are also several reports of definite musical
perceptual and motor disturbances following left-hemisphere lesions in musi-
cians (see Marin, 1982). The only previous study of AP ability following cerebral
damage (Wertheim and Botez, 1961) does raise the question of a possible con-
tribution of left-hemisphere structures to AP. The present case study does not
support this conclusion, at least for lesions of the left temporal lobe. However,
the two cases are clearly not directly comparable due to the very different nature,
extent, and location of the damage. Nevertheless, it is interesting to speculate
that perhaps Wertheim and Botez's patient had not suffered a true loss of AP
ability, but rather had experienced a shift of his internal standard. This conclu-
sion would be supported by the consistent type of transpositional errors their
 Musical abilities and left temporal lobectomy 579

patient made; unfortunately, the data are insufficient to be certain if this was
indeed the case.
The present results are also concordant with studies of temporal lobectomy
subjects. It has been repeatedly found that right temporal lobectomy impairs
various musical abilities, but not basic perceptual functions such as simple pitch
discrimination (Milner, 1962; Shankweiler, 1966; Zatorre, 1985, 1988, 1989 b).
Left temporal lobectomy has not been consistently associated with similar defi-
cits, except when the primary auditory cortex (Heschl's gyri) is included in the
excision (Samson and Zatorre, 1988; Zatorre, 1985), and even then the deficits
are generally milder. Thus, Da.H.'s good performance on musical tasks follow-
ing left temporal excision is in accord with these data. The results of supraspan
digit and spatial block-sequence learning tasks were also in keeping with the
predicted effects of a left temporal and hippocampal resection in that Da:H.
showed clear evidence oflearning the spatial sequence, whereas he did not learn
the digit sequence (Corsi, 1972; Milner, 1978).
Tne results of this one case study do not exclude the possibility that the left
temporal lobe may playa role in other aspects of musical function not tested
here, or that other areas within the left hemisphere may be important as well.
Moreover, the possibility exists that there may be idiosyncratic patterns of
cerebral organization for special skills such as AP, so that the results found with
one person may not be representative of a broader population. Still, in the
absence of evidence to the contrary, it would appear possible to conclude that
even in a trained musician with AP ability, there exists a considerable degree of
independence between the function of the left temporal lobe and the region or
regions that subserve many specialized musical functions.

ABSTRACf

A 17-year old pianist who possessed absolute pitch underwent an anterior left temporal
lobectomy for the relief of intractable seizures. Prior to surgery he showed some fluctua-
tion in the pattern of errors in notating single piano tones. Postoperatively he improved on
this task, and one year later his performance was essentially perfect. On a short-term
retention task given postoperatively he showed the expected effect of a left temporal-lobe
and hippocampal lesion: he was impaired in the recall of a three-letter sequence after 18
sec with an interpolated verbal task. In contrast, retention of the names of three piano
notes was excellent under the same conditions, as it is for control subjects with absolute
pitch. The results are interpreted in terms of the dissociation between verbal mechanisms
and those involved in the coding of pitch, and the seeming immunity of many musical
abilities to the effects of left-hemisphere lesions.

Acknowledgments. I wish to thank Da.H. for his patience and cooperation during
testing, and Dr. A. Olivier for providing detailed neurosurgical information. I am also
indebted to A: Incisa della Rocchetta for carrying out the neuropsychological assessment
and for his observations during a seizure. Helpful comments on the manuscript were
provided by I. Peretz and S. Samson. Some of these results were presented at the Fourth
Annual Symposium on the Medical Problems of Musicians and Dancers, Aspen, Colo-
rado, August 1986. This study was supported in part by the Medical Research Council of
Canada via operating grants MA 9598 to the author and MT 2624 to B. Milner.
580 Robert J. Zatorre

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Robert J. Zatorre, Montreal Neurological Institute, 3801 University St., Montreal, Quebec, Canada H3A 2B4.