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January 1994

A Longitudinal Examination of Crossed Aphasia

Author Affiliations

From the Departments of Neurology (Drs Rey, Levin, Nedd, and Rodas), Psychology (Dr Levin), Radiology (Dr Bowen), and Rehabilitation (Dr Nedd), University of Miami (Fla).

Arch Neurol. 1994;51(1):95-100. doi:10.1001/archneur.1994.00540130129022

Objective:  To longitudinaly examine neuropsychological performance in an adult dextral man with crossed aphasia after cerebrovascular accident.

Design:  Case report using longitudinal neuropsychological, neurological, and radiological examinations performed in close temporal proximity to one another.

Setting:  The patient was seen on both an inpatient and an outpatient basis by members of the Departments of Neurology and Radiology of the University of Miami (Fla) School of Medicine.

Patient:  Thirty-four-year-old right-handed monolingual Hispanic man without family history of lefthandedness.

Results:  Initial neuropsychological testing revealed classic Broca's dysphasia, visual neglect, and visuospatial disturbances. The visuospatial disturbance resolved within 6 months whereas expressive language remained severely impaired. There was a dissociation between praxis and language. Mood was jovial with indifference toward his neurologic and cognitive limitations. Serial magnetic resonance imaging studies unequivocally localized the lesions to the right hemisphere, involving the right frontal, anterior parietal, and subcortical white matter.

Conclusions:  The clinicoanatomic correlation is compatible with the view that crossed aphasia is a "mirror" representation of that seen in cases of uncrossed aphasia. The course of recovery suggests complete lateralization of language to the right hemisphere with bilateral or crossed representation of nonverbal skills.