Abstract Number: Esoc2026ys163 Acquired Amusia as Sole Presenting Symptom of Right Superior Temporal Gyrus Infarction: A Case Report

Abstract Background and aims Acquired amusia is the impaired perception, comprehension or production of music following brain injury, including stroke. This may occur consequent to involvement of temporal branches of the middle cerebral artery (MCA) inferior division. This case report aims to describe the clinical presentation of acquired amusia, explore its underlying mechanisms and its anatomical basis. Methods Case report. Results In 2020, a 73-year-old guitarist underwent a successful thrombolysis and thrombectomy for a Left MCA distribution stroke. He represented to outpatients in 2023 complaining of new onset of inability to identify changes in musical note or tone. He had been commenced on anticoagulation for Atrial Fibrillation following his initial stroke and was found to be adherent with his DOAC. No other neurological deficit was found except for mild right sided muscle hypertonia. The musical difficulty was ascribed to possible hearing loss and recommended to attend an audiologist. In 2025 he represented with an acute right cerebellar infarction. He also reported that his loss of musical perception remained impaired. Repeat CT and MR scans revealed established infarction of his Right temporal lobe affecting superior temporal gyrus and Heschl’s gyrus, areas involved in auditory processing and pitch perception. He was rehabilitated for his cerebellar stroke but was also referred to a music therapist to support rehabilitation of this faculty. Conclusions This case highlights the importance of recognising uncommon post- stroke deficits, including amusia, and tailoring rehabilitation to support recovery. Conflict of interest Deirdre Coyne: nothing to disclose Figure 1 - belongs to Conclusions