Crossed aphasia in a right-handed bilingual Chinese man: a second case

The nature of hemispheric specialization in man

The traditional verbal/nonverbal dichotomy is inadequate for completely describing cerebral lateralization. Musical functions are not necessarily mediated by the right hemisphere; evidence for a specialist left-hemisphere mechanism dedicated to the encoded speech signal is weakening, and the right hemisphere possesses considerable comprehensional powers. Right-hemisphere processing is often said to be characterized by holistic or gestalt apprehension, and face recognition may be mediated by this hemisphere partly because of these powers, partly because of the right hemisphere's involvement in emotional affect, and possibly through the hypothesized existence of a specialist face processor or processors in the right. The latter hypothesis may, however, suffer the same fate as the one relating to a specialist encodedness processor for speech in the left. Verbal processing is largely the province of the left because of this hemisphere's possession of sequential, analytic, time-dependent mechanisms. Other distinctions (e.g., focal/diffuse and serial/parallel) are special cases of an analytic/holistic dichotomy. More fundamentally, however, the left hemisphere is characterized by its mediation of discriminations involving duration, temporal order, sequencing, and rhythm, at thesensory(tactual, visual, and, above all, auditory) level, and especially at themotorlevel (for fingers, limbs, and, above all, the speech apparatus). Spatial aspects characterize the right, the mapping of exteroceptive body space, and the positions of fingers, limbs, and perhaps articulators, with respect to actual and target positions. Thus there is a continuum of function between the hemispheres, rather than a rigid dichotomy, the differences being quantitative rather than qualitative, of degree rather than of kind.

Cortical organization for receptive language functions in Chinese, English, and Spanish: a cross-linguistic MEG study

Chinese differs from Indo-European languages in both its written and spoken forms. Being a tonal language, tones convey lexically meaningful information. The current study examines patterns of neurophysiological activity in temporal and temporoparietal brain areas as speakers of two Indo-European languages (Spanish and English) and speakers of Mandarin-Chinese were engaged in a spoken-word recognition task that is used clinically for the presurgical determination of hemispheric dominace for receptive language functions. Brain magnetic activation profiles were obtained from 92 healthy adult volunteers: 30 monolingual native speakers of Mandarin-Chinese, 20 Spanish-speaking, and 42 native speakers of American English. Activation scans were acquired in two different whole-head MEG systems using identical testing methods. Results indicate that (a) the degree of hemispheric asymmetry in the duration of neurophysiological activity in temporal and temporoparietal regions was reduced in the Chinese group, (b) the proportion of individuals who showed bilaterally symmetric activation was significantly higher in this group, and (c) group differences in functional hemispheric asymmetry were first noted after the initial sensory processing of the word stimuli. Furthermore, group differences in the degree of hemispheric asymmetry were primarily due to greater degree of activation in the right temporoparietal region in the Chinese group, suggesting increased participation of this region in the spoken word recognition in Mandarin-Chinese.

Crossed aphasia: an analysis of the symptoms, their frequency, and a comparison with left-hemisphere aphasia symptomatology

This study presents a thorough analysis of published crossed aphasia (CA) cases, including for the first time the cases published in Japanese. The frequency of specific symptoms was determined, and symptomatology differences based on gender, familial sinistrality, and CA subtype were investigated. Results suggested that the CA population is comparable to the left-hemisphere patient population. However, male were significantly more likely than female CA subjects to show a positive history of familial sinistrality. Typical right-hemisphere (i.e., nonlanguage-dominant) symptoms were frequent but rarely carefully reported or assessed. Results are compared with previous CA reviews and left-hemisphere aphasia. Suggestions for a more systematic assessment of the CA symptomatology are presented.

Selective language aphasia from herpes simplex encephalitis

We report the case of a 16-year-old right-handed Chinese/English bilingual patient who developed herpes simplex encephalitis involving the left temporal lobe, with resultant aphasia. His native language was Mandarin, but he had received extensive training in English for 6 years after moving to the United States and was fluent in English. One week after admission, he could not speak, comprehend, repeat, name, read, or write in English, but he had relative preservation of most of these facilities in Mandarin. He could not write in Mandarin, and his syntax was simplified. Two months later, along with intensive bilingual speech therapy, his reading, writing, and naming in English had almost recovered.

Crossed aphasia. An update

The aim of this article is to present an update of a rare but interesting problem: "crossed aphasia". This term indicates the presence of aphasia after unilateral cerebral lesion of the hemisphere ipsilateral to the patient's dominant hand. We report two cases, review the most relevant literature, and analyze clinical, neuroanatomical, and neurophysiological aspects, taking in consideration the various interpretations proposed to explain this unusual language disorder.

Pure word deafness with possible transfer of language dominance

A 55-year-old, right-handed male patient with a past history of a stroke followed by a difficulty of speech and hearing fell and manifested a left hemiplegia. He could neither comprehend spoken language and melody nor repeat them, though he spoke with paraphasia and understood written language and nonverbal sound. An electroencephalogram, pneumoencephalogram and cerebral angiogram suggested the existence of old infarcts in the left temporal lobe and a probable new one in the right cerebrum. A diagnosis of this case was made as pure word deafness which might be caused by a reimpairment of the language function possibly transferred to the nondominant, right hemisphere following the early stroke.

Aphasia due to lesions confined to the right hemisphere in right handed patients: a review of the literature including the Italian cases

We review most of the work published, to our knowledge, between 1880 and 1988 on aphasia due to right cerebral lesions in right-handed patients ("crossed aphasia"). We summarize the 87 cases found in chronological order within defined groups, dealing in greater detail with the less well-known cases in English-language publications and with the cases from other sources that we consider most representative and convincing. The 87 cases fall into three groups on the following criteria: right-handedness (on standardized tests), absence of left-handers in the family, left hemisphere integrity. Group 1 comprises cases that are unreliable because the handedness data are missing and/or because left hemisphere lesions were known to be present or probably were so. Group 2 comprises cases with full clinical data but no formal test of handedness, with familial cases of left-handedness and/or without satisfactory evidence of left hemisphere integrity. Groups 3 comprises the 26 reliable cases, that is those with proven right-handedness, no left-handers in the family and with proven hemisphere integrity. We discuss the implications of these cases.

Language function and dysfunction among Chinese- and English-speaking polyglots: cortical stimulation, Wada testing, and clinical studies

Language functions in a group of Chinese- and English-speaking polyglots living in a multiracial society have been investigated by several methods: the effects of cortical stimulation on object-naming and reading tasks in patients who required awake craniotomy, lateralization of cerebral dominance for speech by the Wada Test, and the pattern of language loss and recovery following stroke. The data indicate that these polyglots were all left hemisphere dominant for the languages tested: no consistent evidence for increased participation by the right hemisphere for language functions was found. The cortical stimulation experiments provided data most compatible with the "differential localization" model of cerebral localization in bilingualism. The variable which most influenced performance in all of these investigations was which language was used primarily for speaking as well as reading and writing at the time of the study.