A LONGITUDINAL EXAMINATION OF CROSSED APHASIA

Objective: To longitudinally examine neuropsychological performance in an adult dextral man with crossed aphasia after cerebrovascular accid ent. Design: Case report using longitudinal neuropsychological, neurol ogical, and radiological examinations performed in close temporal prox imity to one another.Setting: The patient was seen on both an inpatien t and an outpatient basis by members of the Departments of Neurology a nd Radiology of the University of Miami (Fla) School of Medicine. Pati ent: Thirty-four-year-old right-handed monolingual Hispanic man withou t family history of left-handedness. Results: Initial neuropsychologic al testing revealed classic Broca's dysphasia, visual neglect, and vis uospatial 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 i ndifference toward his neurologic and cognitive limitations. Serial ma gnetic resonance imaging studies unequivocally localized the lesions t o the right hemisphere, involving the right frontal, anterior parietal , and subcortical white matter. Conclusions: The clinicoanatomic corre lation is compatible with the view that crossed aphasia is a ''mirror' ' representation of that seen in cases of uncrossed aphasia. The cours e of recovery suggests complete lateralization of language to the righ t hemisphere with bilateral or crossed representation of nonverbal ski lls.