The many faces of crossed aphasia in dextrals: report of nine cases and review of the literature

In most right-handed people, language and motor functions are more reliant on systems of the left hemisphere while several non-linguistic visuo-spatial and attentional processes depend more on the right hemisphere. The rare exceptions to these rules provide important clues as to what functions co-lateralise, and are thus crucial for models of cerebral specialization. Here we report on the case of a patient, who, after a lesion restricted to the left thalamic region, showed signs normally associated with right hemispheric injury including motor impersistence, visuo-spatial dysfunction and poor comprehension of facial expression. Language abilities were spared and no signs of apraxia were present, in spite of his right hand, foot and eye preference, a pattern normally associated with conventional cerebral dominance. In spite of his other right hemispheric signs, the patient showed no signs of hemi-spatial neglect. The patient's pattern of spared and impaired abilities is compared and contrasted with other rare cases of crossed right hemisphere syndrome.

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“…By contrast, in many cases of crossed aphasia the resultant language disturbances have been transient (Mariën et al 2001).…”

Section: Discussionmentioning

confidence: 97%

“…This was typically the case in "crossed" aphasia (i. e. aphasia following right hemisphere lesions in righthanders, for reviews see Castro-Caldas 1987; Laiacona et al 1996; Mariën et al 2001) and crossed apraxia (Marchetti and Della Sala 1997; Raymer et al 1999). …”

Section: Introductionmentioning

confidence: 99%

Crossed right hemisphere syndrome following left thalamic stroke

2005

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“…Right hemisphere stroke is only responsible for approximately 4% of poststroke aphasia and occurs in right- or left-handed or ambidextrous patients with their language representation in the right hemisphere [1,46,47]. For right-handers, the term ‘crossed aphasia' is used, but right hemisphere stroke aphasia is more often seen in left-handers.…”

Section: Discussionmentioning

confidence: 99%

Noninvasive Brain Stimulation for Treatment of Right- and Left-Handed Poststroke Aphasics

Heiss

Hartmann²,

Rubi-Fessen³

et al. 2013

Cerebrovasc Dis

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Background: Accumulating evidence from single case studies, small case series and randomized controlled trials seems to suggest that inhibitory noninvasive brain stimulation (NIBS) over the contralesional inferior frontal gyrus (IFG) of right-handers in conjunction with speech and language therapy (SLT) improves recovery from poststroke aphasia. Application of inhibitory NIBS to improve recovery in left-handed patients has not yet been reported. Methods: A total of 29 right-handed subacute poststroke aphasics were randomized to receive either 10 sessions of SLT following 20 min of inhibitory repetitive transcranial magnetic stimulation (rTMS) over the contralesional IFG or 10 sessions of SLT following sham stimulation; 2 left-handers were treated according to the same protocol with real rTMS. Language activation patterns were assessed with positron emission tomography prior to and after the treatment; 95% confidence intervals for changes in language performance scores and the activated brain volumes in both hemispheres were derived from TMS- and sham-treated right-handed patients and compared to the same parameters in left-handers. Results: Right-handed patients treated with rTMS showed better recovery of language function in global aphasia test scores (t test, p < 0.002) as well as in picture-naming performance (ANOVA, p = 0.03) than sham-treated right-handers. In treated right-handers, a shift of activation to the ipsilesional hemisphere was observed, while sham-treated patients consolidated network activity in the contralesional hemisphere (repeated-measures ANOVA, p = 0.009). Both left-handed patients also improved, with 1 patient within the confidence limits of TMS-treated right-handers (23 points, 15.9-28.9) and the other patient within the limits of sham-treated subjects (8 points, 2.8-14.5). Both patients exhibited only a very small interhemispheric shift, much less than expected in TMS-treated right-handers, and more or less consolidated initially active networks in both hemispheres. Conclusion: Inhibitory rTMS over the nondominant IFG appears to be a safe and effective treatment for right-handed poststroke aphasics. In the 2 cases of left-handed aphasics no deterioration of language performance was observed with this protocol. However, therapeutic efficiency is less obvious and seems to be more related to the dominance pattern prior to the stroke than to the TMS intervention.

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“…In the subject literature there are a few reports dedicated to the treatment of patients with post-traumatic crossed aphasia (30,31). This is the case also with aphasia in the world literature, and although much attention has been devoted to the topic of crossed aphasia in dextrals (CAD) over the past century, there is still no theory to explain the anomalous organization of neurocognitive functions, although it is thought that this is a genetic issue, one connected with the handedness in this population.…”

Section: Discussionmentioning

confidence: 99%

“…tDCS has the advantage of being easier to use in double-blind or sham-controlled studies and easier to apply concurrently with behavioural tasks [29]. Despite their differences, both TMS and tDCS can induce long-term after-effects on cortical excitability that can last for months [31,32]. These long-term after-effects are believed to engage the mechanisms of neural plasticity, making these techniques ideally suited in the rehabilitation of strokes and TBI [33].…”

Section: Discussionmentioning

confidence: 99%

Application of ERPs neuromarkers for assessment and treatment of a patient with chronic crossed aphasia after severe TBI and long-term coma – Case Report

Chantsoulis¹,

Półrola²,

Góral-Półrola³

et al. 2017

Ann Agric Environ Med.

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Objective. The study aimed to evaluate the application of ERPs neuromarkers for the assessment and treatment of a patient with chronic crossed aphasia after severe TBI and a long-term coma. Case report. An ambidextrous female patient, aged 29, suffered from posttraumatic chronic crossed aphasia, severe TBI and a prolonged coma after a car accident. The patient took part in two differentiated rehabilitation programmes of neurotherapy included 20 sessions of relative beta training and 20 sessions of rTMS; both programmes were combined with behavioural training. The patient was tested 3 times: before the experiment, after completion of programme A, and after completion of programme B. Results. In the 1 st recording, the neuromarker of aphasia was found -an excess of the P2 wave over the left temporal area. There was a cognitive control deficit -an excess of omission errors and an increase of RT variability -all indexes of sporadic ADHD. In the 2 nd recording, slight improvements in cognitive control, and language functions were found. In the 3 rd recording, after the rTMS sessions most of her cognitive dysfunctions had been resolved, including language functions. It should be stressed that the activation (especially the increase in the ERP potential of the right side over the frontal lobe) was found. The neuromarker of aphasia did not change, only the location had slightly moved frontally. Conclusions. The application of ERP neuromarkers assists in the diagnosis, treatment, and academic success of an ambidextrous patient with chronic posttraumatic aphasia and sporadic ADHD. ERPs can be used to assess the functional brain changes induced by neurotherapeutical programmes.

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The many faces of crossed aphasia in dextrals: report of nine cases and review of the literature

Cited by 40 publications

References 42 publications

Crossed right hemisphere syndrome following left thalamic stroke

Crossed right hemisphere syndrome following left thalamic stroke

Noninvasive Brain Stimulation for Treatment of Right- and Left-Handed Poststroke Aphasics

Application of ERPs neuromarkers for assessment and treatment of a patient with chronic crossed aphasia after severe TBI and long-term coma – Case Report

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