Advertisement

Journal of Neurology

, Volume 265, Issue 7, pp 1671–1675 | Cite as

Crossed aphasia following cerebral infarction in a right-handed patient with atypical cerebral language dominance

  • Xiaoping Tan
  • Yang Guo
  • Saihong Dun
  • Hongzan Sun
Original Communication
  • 164 Downloads

Abstract

Objective

Crossed aphasia (CA), usually referred to as an acquired language disturbance, is caused by a lesion in the cerebral hemisphere ipsilateral to the dominant hand, and the exact mechanism is not clear. The development of handedness is influenced by education and training and the impact of habitualization, while language is more susceptible to the impact of speech habits, and it is not absolutely accurate to judge cerebral language dominance by the degree of hand preference.

Methods

We describe a case of CA after right hemispheric stroke in a right-handed patient with atypical language dominance and attempt to analyze the mechanism of CA based on functional imaging methods, including arterial spin labeling (ASL) and positron emission tomography/magnetic resonance imaging (PET-MRI).

Results

Brain MRI at 24 h after admission showed a large cerebral infarction in the right cerebral hemisphere, including the posteroinferior part of Broca’s area in the right frontal lobe, the right temporal lobe, and the right occipital lobe. The patient exhibited a non-fluent aphasia on a standard language test (the Aphasia Battery of Chinese [ABC]) performed on the 7th day after onset. Thus, atypical language dominance was suspected. One week after admission, ASL imaging showed high perfusion in the infarct core zone and low perfusion in the left cerebellar hemisphere. Two months later, PET/MRI demonstrated low metabolism in the posterior frontal lobe, temporal lobe, temporal occipital junction area, and the right basal ganglia.

Conclusion

The findings suggest that the patient has right-sided cerebral language dominance, or that both hemispheres have linguistic functions. Not all patients show linguistic capabilities on the side opposite hand preference. The language dominance should be predicted by a combination of clinical manifestations and functional imaging techniques.

Keywords

Brain infarction Crossed aphasia Diaschisis Atypical language dominance 

Notes

Compliance with ethical standards

Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standards

This study was approved by the local Institutional Review Board and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from the patient.

References

  1. 1.
    Pujol J, Deus J, Losilla JM, Capdevila A (1999) Cerebral lateralization of language in normal left-handed people studied by functional MRI. Neurology 52(5):1038–1043CrossRefPubMedGoogle Scholar
  2. 2.
    Knecht S, Drager B, Deppe M, Bobe L, Lohmann H, Floel A et al (2000) Handedness and hemispheric language dominance in healthy humans. Brain 123(Pt 12):2512–2518CrossRefPubMedGoogle Scholar
  3. 3.
    Szaflarski JP, Binder JR, Possing ET, McKiernan KA, Ward BD, Hammeke TA (2002) Language lateralization in left-handed and ambidextrous people: fMRI data. Neurology 59(2):238–244Google Scholar
  4. 4.
    Mariën P, Paghera B, De Deyn P, Vignolo L (2004) Adult crossed aphasia in dextrals revisited. Cortex 40:41–74Google Scholar
  5. 5.
    Vassal M, Le Bars E, Moritz-Gasser S, Menjot N, Duffau H (2010) Crossed aphasia elicited by intraoperative cortical and subcortical stimulation in awake patients. J Neurosurg 113:1251–1258CrossRefPubMedGoogle Scholar
  6. 6.
    Coppens P, Hungerford S, Yamaguchi S et al (2002) Brain Lang 83:425–463CrossRefPubMedGoogle Scholar
  7. 7.
    Bakar M, Kirshner HS, Wertz RT (1996) Crossed aphasia: functional brain imaging with PET or SPECT. Arch Neurol 53:1026–1032CrossRefPubMedGoogle Scholar
  8. 8.
    Yumei Z, Yongjun W, Ruihua M et al (2005) Clinical Research on the relationship between the hand-preference and language dominant hemisphere. Chin J Rehabil Med 20(4):281–282Google Scholar
  9. 9.
    Somers M, Aukes MF, Ophoff RA et al (2015) On the relationship between degree of hand-preference and degree of language lateralization. Brain Language 144:10–15CrossRefPubMedGoogle Scholar
  10. 10.
    Ishizaki M, Ueyama H, Nishida Y et al (2012) Crossed aphasia following an infarction in the right corpus callosum. Clin Neurol Neurosurg 114(2):161–165CrossRefPubMedGoogle Scholar
  11. 11.
    Cappa SF, Perani D, Bressi S et al (1993) Crossed aphasia: a PET follow up study of two cases. J Neurol Neurosurg Psychiatry 56(6):665–671CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Abe K, Ukita H, Yorifuji S et al (1997) Crossed cerebellar diaschisis in chronic Broca’s aphasi. Neuroradiology 39:624–626CrossRefPubMedGoogle Scholar
  13. 13.
    Habib M, Joanette Y, Ali-Cherif A, Poncet M (1983) Crossed aphasia in dextrals: a case report with special reference to site of lesion. Neuropsychologia 21:413–418CrossRefPubMedGoogle Scholar
  14. 14.
    Kim WJ et al (2013) Neural substrate responsible for crossed aphasia. J Korean Med Sci 28:1529–1533CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Baxendale S (2009) The Wada test. Curr Opin Neurol 22(2):185–189CrossRefPubMedGoogle Scholar
  16. 16.
    Abou-Khalil B (2007) An update on determination of language dominance in screening for epilepsy surgery: the Wada test and newer noninvasive alternatives. Epilepsia 48(3):442–455CrossRefPubMedGoogle Scholar
  17. 17.
    De Witte E, Van Hecke W, Dua G et al (2014) Atypical cerebral language dominance in a right-handed patient: an anatomoclinical study. Clin Neurol Neurosurg 117:12–21CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurologyShengjing Hospital of China Medical UniversityShenyangPeople’s Republic of China
  2. 2.Department of RadiologyShengjing Hospital of China Medical UniversityShenyangPeople’s Republic of China

Personalised recommendations