In pure word deafness, comprehension and repetition of speech are impaired, but reading, writing, and spontaneous speech are preserved. Pure word deafness is distinguished from generalized auditory agnosia by the preserved ability to recognize environmental sounds. We examined a patient with pure word deafness associated with bilateral infarctions of the primary auditory cortex, who could use auditory affective intonation to enhance comprehension. The primary auditory cortex seems to be essential for comprehending speech, but comprehension of nonverbal sounds and affective prosody may be mediated by other cerebral structures such as the auditory association cortex. © 1983 American Academy of Neurology.