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Crossed aphasia following cerebral infarction in a right-handed patient with atypical cerebral language dominance

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Abstract

Objective

Crossed aphasia (CA), usually referred to as an acquired language disturbance, is caused by a lesion in the cerebral hemisphere ipsilateral to the dominant hand, and the exact mechanism is not clear. The development of handedness is influenced by education and training and the impact of habitualization, while language is more susceptible to the impact of speech habits, and it is not absolutely accurate to judge cerebral language dominance by the degree of hand preference.

Methods

We describe a case of CA after right hemispheric stroke in a right-handed patient with atypical language dominance and attempt to analyze the mechanism of CA based on functional imaging methods, including arterial spin labeling (ASL) and positron emission tomography/magnetic resonance imaging (PET-MRI).

Results

Brain MRI at 24 h after admission showed a large cerebral infarction in the right cerebral hemisphere, including the posteroinferior part of Broca’s area in the right frontal lobe, the right temporal lobe, and the right occipital lobe. The patient exhibited a non-fluent aphasia on a standard language test (the Aphasia Battery of Chinese [ABC]) performed on the 7th day after onset. Thus, atypical language dominance was suspected. One week after admission, ASL imaging showed high perfusion in the infarct core zone and low perfusion in the left cerebellar hemisphere. Two months later, PET/MRI demonstrated low metabolism in the posterior frontal lobe, temporal lobe, temporal occipital junction area, and the right basal ganglia.

Conclusion

The findings suggest that the patient has right-sided cerebral language dominance, or that both hemispheres have linguistic functions. Not all patients show linguistic capabilities on the side opposite hand preference. The language dominance should be predicted by a combination of clinical manifestations and functional imaging techniques.

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Authors and Affiliations

  1. Department of Neurology, Shengjing Hospital of China Medical University, 39 Hua Xiang Road, Tie Xi District, Shenyang, 110022, Liaoning, People’s Republic of China

    Xiaoping Tan, Yang Guo & Saihong Dun

  2. Department of Radiology, Shengjing Hospital of China Medical University, 39 Hua Xiang Road, Tie Xi District, Shenyang, 110022, Liaoning, People’s Republic of China

    Hongzan Sun

Authors
  1. Xiaoping Tan
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  2. Yang Guo
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  3. Saihong Dun
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  4. Hongzan Sun
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Corresponding author

Correspondence to Xiaoping Tan.

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Conflicts of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical standards

This study was approved by the local Institutional Review Board and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed consent

Informed consent was obtained from the patient.

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Tan, X., Guo, Y., Dun, S. et al. Crossed aphasia following cerebral infarction in a right-handed patient with atypical cerebral language dominance. J Neurol 265, 1671–1675 (2018). https://doi.org/10.1007/s00415-018-8901-0

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  • DOI: https://doi.org/10.1007/s00415-018-8901-0

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