Anomalous cerebral language organization: Acquired crossed aphasia in a dextral child

Following a dramatic change of its reported incidence, it was only recently recognized that acquired crossed aphasia in dextral children represents a highly exceptional phenomenon. We describe in a three epoch time-frame mode l the aphasic and neurocognitive manifestations of an additional case and f ocus briefly on its anatomoclinical configurations. In our patient, a right parietal cortico-subcortical hemorrhagic lesion caused an initially severe aphasia. After remission of the global aphasic symptoms in the acute phase , an adynamic output disorder with relatively severe auditory-verbal compre hension disturbances developed. In addition to the adynamia of self generat ed speech, formal language investigations performed 3 weeks postonset, reve aled agrammatism, hypertonic dysarthria, and dysprosodia. A substantial imp rovement of the aphasic disorder was objectified 83 days postonset. Neurops ychological investigations disclosed both dominant and nondominant hemisphe re dysfunctions. Reassess ment of neurocognitive functions after a 10-year period evidenced discrete residual anemia, confined to visual confrontation al naming and a discrete visuo-perceptual syndrome. Given the posterior loc alization of the lesion, the syndrome shift from global to predominantly ad ynamic aphasia represents a finding beyond the plausible anatomoclinical ex pectations holding in general for the uncrossed, classic types of childhood and adult aphasia. As the first representative of crossed aphasia in dextr al children with an anomalous lesion-aphasia profile, our case provides evi dence to enrich the discussion on lateralization and intrahemispherical org anization of language functions in both childhood and adult aphasia. (C) 20 01 Academic Press.