Diagnosis of crossed aphasia, a case report

Abstract

The purpose was to back up on all the arguments [1] , for to diagnose crossed aphasia (CA) our patient and improve rehabilitation. A man of 45 years, right-handed, presented a dysarthria accompanied by a loss of verbal fluency, lack of word and paraphasias, after a parietal-temporal hematoma in right hemisphere. The interrogatory did not find a familial history on a left handedness. Brain imaging confirmed the integrity of the left hemisphere in the initial MRI and CT scan. The speech therapist assessment showed the oral picture naming test alack of the word (61/80, decreased lexical background, non-response, breaks) and semantic paraphasias. The questionnaire of the Boston Diagnostic Aphasia Examination of the repetition of sentences showed an effect of length and omissions of words. Reading words and sentences aloud contained substitutions, additions and paralexies. Listening was average (11/15: order execution, 6/12: understanding sentences and texts). Reading comprehension was average, 6/10. The writing contained many errors (perseveration, paragraphies literal and neologisms). The copy was altered. Automatic series were not preserved (Transcript of the alphabet). Brain lateralization test found an ocular dominance right and right lower limb (20/20). Neuropsychological assessment found disorders of attention (Stroop and Trail Making Test [TMT] with 4.12 standard deviation [sd] and the corrected T score 1.9 and 2.4 sd) and mental flexibility (TMT: 3.41 sd). An impaired working memory (WAIS: span = 7 and to place = 3) and logical reasoning (WAIS-III: 5). A deficit in verbal episodic memory (learning the verbal list of BEM 144: 1.31 sd) affect the encoding and retrieval processes. We have thus confirmed the diagnosis of crossed aphasia by eliminating a left handedness and a lesion in the left hemisphere. The speech therapist and neuropsychological allowed to assert the diagnosis of aphasia associated with cognitive disorders [2] . Therefore we associated the language rehabilitation in a targeted program on cognitive function and gained better results.