I read Serafetinides' letter with interest. My colleagues and I1 did, indeed, attribute the obtundation of patient 2 during the left hemisphere intracarotid sodium amobarbital test as probably being due to cross-fill of amobarbital into the contralateral anterior cerebral artery territory, thereby leading to bilateralfrontal deactivation. Other possibilities were, however, considered, even if they were not discussed in that article. One of these possibilities was that of cerebral dominance for consciousness. The studies mentioned in Serafetinides' letter (eg, Serafetinides et al2) reported that inactivation of the language-dominant (usually left) hemisphere resulted in alterations in consciousness that were only infrequently seen (and were of shorter duration) with inactivation of the other hemisphere. Similar findings have been made in patients with cerebrovascular accidents.3While such findings have profound import for concepts of cerebral lateralization and consciousness, they are not without their share of controversy. In their landmark
Ahern GL. Cerebral Laterality and Consciousness-Reply. Arch Neurol. 1995;52(4):337–338. doi:10.1001/archneur.1995.00540280017004
Monkeypox Resource Center
Customize your JAMA Network experience by selecting one or more topics from the list below.