Nine patients with aphasia had right ear extinction in dichotic listening to words in the first month after an ischemic stroke; they were reassessed after 3 months. Four showed complete recovery from the right ear extinction; in five, the abnormality persisted. In those who recovered, CT revealed a subcortical lesion lateral to the frontal horn of the lateral ventricle without a lesion of Heschl's gyrus or geniculo-temporal pathways; a lesion in those structures was found in patients who did not recover. As reported for subcortical aphasia, a subcortical mechanism may explain contralateral ear extinction in dichotic listening.
Crossed aphasia is reported to be more frequent in traumatic series than in series of patients with other pathologies. A right-handed young man suffered a closed-head trauma and became aphasic and hemiparetic on the left. CT scan revealed a right frontal-lobe hematoma. Neuropsychological examination revealed a fluent aphasia and a Gerstmann syndrome. These signs were compatible with left supramarginal gyrus syndrome. However, the presence of a right frontal-lobe lesion suggested that this patient could be a crossed aphasic. Subsequent EEG study showed a left occipitotemporal focus and a right frontal one. Aphasic signs could thus be due to the left lesion, which was the result of a contrecoup mechanism. Fluent aphasias have been reported in closed-head trauma with right frontal impact. Attention is called for the possible bias of including cases like this in series of traumatic crossed aphasia.
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