Abstract
Crossed aphasia in dextrals (CAD) following pure subcortical lesions is rare. This study describes a right-handed patient with an ischemic lesion in the right thalamus. In the post-acute phase of the stroke, a unique combination of ‘crossed thalamic aphasia’ was found with left visuo-spatial neglect and constructional apraxia. On the basis of the criteria used in Mariën et al. [67], this case-report is the first reliable representative of vascular CAD following an isolated lesion in the right thalamus. Furthermore, this paper presents a detailed analysis of linguistic and cognitive impairments of ‘possible’ and 'reliable' subcortical CAD-cases published since 1975. Out of 25 patients with a pure subcortical lesion, nine cases were considered as ‘possibly reliable or reliable’. A review of these cases reveals that: (1) demographic data are consistent with the general findings for the entire group of vascular CAD, (2) the neurolinguistic findings do not support the data in the general CAD-population with regard to (a) the high prevalence of transcortical aphasia and (b) the tendency towards a copresence of an oral versus written language dissociation and a ‘mirror-image’ lesion-aphasia profile, (3) subcortical CAD is not a transient phenomenon, (4) the lesion-aphasia correlations are not congruent with the high incidence of anomalous cases in the general CAD-population, (5) neuropsychological impairments may accompany subcortical CAD.
Highlights
At the end of the 19th century, the so-called Broca’s doctrine assigned left hemisphere dominance for language to dextrals and right hemisphere dominance to sinistrals
The demographic data of this small group are consistent with the general findings in the entire group of vascular crossed aphasia in dextrals’ (CAD) which show that CAD patients are not younger than non-crossed aphasics nor that CAD is more frequent in women than men [67]
‘crossed thalamic aphasia’ was found with left visuospatial neglect and constructional apraxia. This patient represents the first reliable representative of CAD following an isolated lesion in the right thalamus
Summary
At the end of the 19th century, the so-called Broca’s doctrine assigned left hemisphere dominance for language to dextrals and right hemisphere dominance to sinistrals. As an exception to this dogma, Byrom Bramwell [5] introduced the term crossed aphasia (CA) to denote any aphasic syndrome resulting from a cerebral lesion ‘ipsilateral’ to the dominant hand. Bramwell considered this exceptional phenomenon as a transient condition in right-handers. During the following decades several studies documented persistent aphasia in dextrals due to a right hemisphere lesion [22,23,24,25,48,58]. De Witte et al / Crossed aphasia and visuo-spatial neglect following a right thalamic stroke aphasia in left-handers is the rule and not the exception, crossed aphasia became the synonym for ‘crossed aphasia in dextrals’ (CAD)
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