afasia cruzada.pdf

7/28/2019 afasia cruzada.pdf

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N e u ro p s \ c h o l o g > C o p y r i g h t 1 ^ 9 1 b y t t w E d u c a t i o n a l P u b l i s h i n g F o u n d a t i o nWl.Vd. 5. No. 2.67-T) 0 8 94 - 4 10 5 / 91 / 5 3 .0 0

Reversed Laterality and Crossed Aphasia:A Case Study

G LE N N J . L A R R A B E EMemory Assessment Clinics, I n c .Sarasota, FloridaDepartment of NeurologyU n i v e r s i t y of South Florida College of MedicineTampa, FloridaJames A. H a l e y Veterans Administration HospitalTampa, FloridaD O R E E N G. H O L L I M A NVeterans Administration Medical CenterBirmingham. AlabamaSALLY Z A C H A R I A HDepartment of NeurologyU n i v e r s i t y of South Florida College of MedicineTampa. FloridaB a y Pines Veterans Administration HospitalB a y Pines, Florida

Abstract: Detailed neuropsychological data are presented on a dextral man who,following right anterior temporal lobectomy fo r astrocytoma, manifested anomicaphasia, preserved ideomotor praxis, and good visuospatial and visual memoryskills. Th is performa nce pattern is analyzed in reference to other cases of crossedaphasia, and provides further support for the thesis that crossed aphasic syn-dromes frequently parallel traditional l e f t hemisphere dominant aphasic syn-dromes. The presence of preserved ideomotor praxis and good visuospatial andvisual memory skills is considered in relation to the construct of reversed lateralityand more complex models of lateral!zation of cerebral functions.Keywords: Crossed a phas ia , case s tudy , a s t rocy toma, neuropsycho logica l meas-u r e m e n t s .

Crossed aphasia, or the presence of aphasic symptoms in dextrals with righthemisphere disease, is rare. Estimates of the f r e q u e n c y of such atypical hemisphericdominance range from 0.38% (Hecaen, Mazars, Ramier, Goldblum, & Merienne,

Address correspondence te G l e n n J . Larrabee, Memory Assessmen t Cl in ics , I nc . , 1 2 1 7East Ave nu e South , Sui te 209, Sarasota, Florida 34239.67


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68 Glenn J. Larrabee el at.1 9 7 1 ) to 2 . 6 % ( R o b e r t , 1 9 6 9 ) . R e c e n t i n v e s t i g a t i o n s o f crossed aphasia ha ve focusedo n t h r e e m a i n i s s u e s : (a ) I s h e m i s p h e r i c d o m i n a n c e r eve rs e d , w it h l a n g u a g erep resen ted i n the r igh t h e m i s p h e r e a n d spa t ia l fun c t io n s r ep resen ted i n the left?(b) Do crossed a phas ia sy nd rom es pa ra l le l th e t y p i c a l left h e m i s p h e r e a p h a s i c

s y n d r o m e s ? a nd (c ) I s p r a x i s in crossed aphasics governed by the l a n g u a g e d o m i n a n th e m i s p h e r e , or by the h e m i s p h e r e c o n t r a l a t e ra l to the d o m i n a n t h a n d ?T h e t e r m reversed laterally or ig ina l l y w a s u se d b y T a y l o r a n d S o l o m o n ( 1 9 7 9 )to descr ibe a de x t r a l who developed impa i red v i suospa t i a l ab i l i ty wi tho u t aph as iafo l lowing a l e f t h e m i s p h e r e C V A . S u bs e q u e n t c a se s w i t h s i m i l a r m a n i f e s t a t i o n sfo l lowing l e f t h e m i s p h e r e C V A ha ve been r epor ted (Ju n qu e , L i tvan , & V e n d r e l l .1986; P o d b r o s & DePiero . 198 5 ) . Brown a n d W i l s o n ( 1 9 7 3 ) a n d Larrabee, K a n e ,a n d R o d g e r s ( 1 9 8 2 ) have repor ted cases o f crossed aphasia in d e x t r a l s w h o d i d n o tsuffer from visuospa t i a l d i s tu rban ces . Other cases h ave been repor t ed , h o w e v e r ,w h e r e de x t r a l s have p resen ted with a p h a s i a a n d s p a t i a l i m p a i r m e n t s fol lowing r i g h tC V A . A l t h o u g h some of these c rossed aphas ics had au d i to ry com prehe ns ionp r o b l e m s t h a t c o u l d h a v e c o n t r i b u t e d t o p o o r s p a t i a l p e r f o r m a n c e ( H a m s h e r ,1 9 8 1 ) . crossed aphasic cases h a v i n g s p a t i a l def ic i ts w i t h o u t co m p r e h e n s i o n i m p a i r -m e n t h a v e be e n r e p or te d (Car r . Jacobson , & Boi le r . 1 9 8 1 ; C l a r k e & Z a n g w i l l . 1965;H a a l a n d & M i r a n d a . 198 2 ) . H e n d e r s o n ( 1 9 8 3 ) and Basso. Cap i t an i , La iacona , a ndZ a n o b i o ( 1 9 8 5 ) r epor ted cases o f c rossed W ern icke aphas ia wi th qua l i t a t ive e r ro rso n c o n s t r u c t i o n a l ta s k s s u g g e s ti ve o f spat ia l ly based cons t ruc t iona l ap rax ia .T h e i ss u e o f w h e t h e r c ro ss ed a p h a s i a r e p r e se n t s a u n i q u e la n g u a g e s y n d r o m eo r pa ra l l e l s m o r e t r a d i t i o n a l a p h a s ic s y n d r o m e s fol lowing left h e m i s p h e r e d a m a g eh a s been addressed in severa l s tudies . Orig ina l ly . Brown a n d W i l s o n ( 1 9 7 3 ) a rguedthat most cases of crossed aphasia m a n i f e s t a u n i q u e l a n g u ag e s y n d r o m e c h a ra c -te r ized by a g r a m m a t i c s p e e ch , fair n a m i n g a n d r epe t i t ion , a n d m o d e r a t e l y i m p a i r e dc o m p r e h e n s i o n . A s imi la r apha s ic pa t t e rn has been r eported in a case described byK a p u r a n d D u n k l e y ( 1 9 8 4 ) . Others have repor ted cases tha t para l le l left h e m i s p h e r ea p h a s i c s y n d r o m e s i n c l u d i n g Broca 's aphas ia , g loba l aphas ia and t r ansco r t i ca lsenso ry apha s ia (Car r et al.. 1981 ) , c o n d u c t i o n a p h a s ia ( Ha a l a n d & M i r a n d a , 1 9 8 2 ) .subcor t i ca l a p h a s i a ( H a b i b . J o a n e t t e , Ali-Cher i f , & Ponce t , 1983 ; Sap i r, K okm en ,& Rogers , 1986) . and W ern icke aphas ia (Hen de r son , 1983) . Mo reover, Cas t ro -C a l d a s a n d C o n f r a r i a ( 1 9 8 4 ) no ted tha t the r ep resen ta t ion o f Broca , g loba l , Wer -n i c k e . t r ansco r t i ca l . and conduc t ion aphas ia in c rossed aphas ics was no t on lypro po r t ion ate to the f reque nc ies observed in uncrossed aphasics . but a lso ref lectedthe same age-rela ted associa t ions of these aphasic syndromes. Last ly . Basso et a l .( 1 9 8 5 ) have repor ted crossed aphasia cases with cha rac te ri s ti cs o f Wern icke a phas iaa n d B ro c a a p h a s ia , w i t h n o s u p p o r t f o r B r o w n 's h y p o t h e s is o f a u n i q u e s y n d r o m eof crossed aphasia .A l t h o u g h cases of crossed aphas ia have been accompan ied by apraxia (Bassoe t al . , 19 85; Hen de rson , 1983) , severa l invest iga tors have suggested tha t praxis isg o v e r n e d b y t h e h e m i s p h e r e c o n t r a l a t e r a l t o t h e d o m i n a n t h a n d i n c ro ss ed a p h a si cs ,r a t h e r t h a n by the l a n g u a g e - d o m i n a n t i p s i l a t e r a l h e m i s p h e r e ( B r o w n & W i l s o n ,1 9 7 3 ; H a a l a n d & M i r a n d a , 1 9 8 2 ; K a p u r & Dunkley. 1984; Larrabee e t al., 1982 ) .If t h i s is t rue, then cases o f r ever sed l a te r a l i ty suffering spat ia l def ici ts but noa p h a s i a fol lowing left h e m i s p h e r e d a m a g e s h o u l d d e m o n s t r a t e i d e o m o t o r a p r a x ia .Of four cases repor ted with n o aphas ia fo l lowing left C V A , p r a x i s wa s e x a m i n e din t w o ( J u d d , 1 9 8 9; J u n q u e e t al., 1986) and was foun d to be impa i red . Tay lo r andS o l o m o n ( 1 9 7 9 ) a n d P o d b ro s a n d D e P i e ro ( 1 9 8 5 ) did not evaluate praxis . I t i s


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Crossed Aphasia 69n o t e w o r t h y t ha t P odbros an d DePiero observed tha t t he i r pa t i e n t had perseverat iveerrors in wri t ing . It is possible that these errors were secondary to ap rax ia .Th e curren t ca se demons t ra t es a pa t t e rn o f crossed aphasia with preservedspa t ia l ab i li t ies and p reserved ideom oto r p rax i s i n a 2 8-yea r-o ld , r igh t -hand ed m an ,following r igh t f ron to tempora l c ran io tomy fo r an as t rocytoma, grade II . Thepa t t e rn o f cerebra l organiza t ion is related to pas t s tud ies o f crossed aphasia an dreversed la tera l i ty , and to the variou s types of cerebra l org an iza t ion of langu age,spa t i a l fu n c t i o n s , a n d praxis .

Case ReportThe pa t i en t , a 28-yea r-o ld , r igh t -handed man with a BS degree i n phys ica l educa -t i o n , was in his usual s ta te o f good hea l th u n t i l suffer ing onset of o l fac to ryh a l l u c i n a t i o n s in September 1985. On e m o n t h l a t e r h e suffered a par t i a l complexse izure with seconda ry genera l i za t ion . Over th i s t ime per iod , the pa t ient a lsocom pla ined o f p roblems wi th recen t m em ory . On subsequen t eva lu a t ion , a com -pute r ized t omography (CT) scan was in t e rp re t ed a s dep ic t i ng a mass l es ion in ther igh t f ron to tempo ropa r i e t a l a rea ( see F igu re 1) . Ma g n e t i c r es o n a n c e i m a g i n g ( M R I )a l so was cond uc ted and reflec ted a 6 x 4 cm m ass in the r igh t f ron topar ie ta l areawith extens ive subcor t ica l i n v o l v e m e n t (s e e F i g u re 2 ) o f the r igh t c a u d a t e n u c l e u s ,a n t e r io r aspec t o f the r igh t i n t e r na l capsu le , pu t am en , ex te rna l capsu le , an d g lobuspa l l i dus . There was a m i l d r ight- to- lef t shift preopera t ive ly .

Figure 1 . C o m p u t e r i z e d t o m o g ra p h y sc a n with c o n t r a s t sh o wi n g well-def ined n o n e n h a n c -in g b i lob u la t ed les ion o f d e c re a se d a t t e n u a t i o n i n the r igh t f ron to tempora l reg ion assoc ia tedwith so m e m a ss effect with n o m i d l i n e shift.


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70

1 ' i yurc 2 . MRI o la I w e i g h t e d image demonstrating th e right frontotemporal \ \ e l l - d c t i n c dmass of high signal i n t e n s i t y .

l''i(jurc 3. Computerized tomograph) scan obtained S w e e k s alter su rge r \ s h o w i n g resolu-tion of mass hu t an enhancing i n fa re t i n t he right middle ce rebra l ar t e r s distribution.


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Crossed Aphasia 71In N o v e m b e r 1 9 8 5 , th e p a t i e n t u n d e r w e n t r i g h t fr o n t o t e m p o r a l c r a n i o t o m y ,with s u b te m p o r a l d e c o m p r e s s io n . The r igh t an te r io r tempora l l obe wa s excised ,s p a r i n g th e c o m m u n i c a t i n g v e i n o f Labbe, up to the s u p e r io r t e m p o r a l gyrus . T h esuper io r su r face of the tempora l l obe was left to p rese rve the t r ansverse tempora l

gyrus o f Heschl . Pathological d iagnosis wa s cons is ten t wi th astrocytoma, grade II.I m m e d i a t e l y p o s to p e r a t iv e ly , t h e p a t i e n t h a d a d e n s e left h e m ip a r e s i s a n d w a sle tharg ic , ye t would obey some verba l com ma nd s . A g loba l aphas ia appeared to bepresen t , and he had a s l igh t r igh t gaze p re fe rence . By h is th i rd pos tope ra t ive da y ,he was able to obey ve rba l com m an ds bu t s t i ll wou ld no t speak . He received 6 ,000rads of whole brain radiation over a 6-week pe r iod fo l lowing surge ry . In Ja nu ar yo f 1 9 8 6 , h e h a d c o n t i n u i n g aphas ic s y m p t o m s i n c l u d i n g s ign if ican t w o r d - f i n d i n gp r o b l e m s a n d s p e l l i n g problems , a l t h o u g h g oo d g r a m m a t i c c o m p r e h e n s io n w a spresen t . Subsequen t CT scan wi th con t ras t (F igure 3 ) showed re so lu t ion of them a s s but an e n h a n c i n g i n fa rc t in the r igh t m idd le ce rebra l a r te ry d i s t r ibu t ion th a tsubsequen t ly resolved in a la ter CT scan . The mild , r ight- to-lef t shift seen preop-era t ively w a s n o t presen t pos tope ra t ive ly . Consequen t ly , th e a p h a s i a , w h ic h o n l yappeared pos tope ra t ive ly , canno t be a t t r ibu ted to p reopera t ive mid l ine shift.T h e p a t i e n t wa s t ransfe r red to the J a m e s A . H a l ey V e t e ra n s A d m i n i s t ra t i o nHosp i t a l in Apr i l 1986. De ta i l ed l anguage and neuropsycholog ica l eva lua t ion wasc o n d u c t e d in Apr i l , wi th repea ted l anguage examina t ion in August 1986. Ah a n d e d n e s s i n v e n to r y (L e za k , 1 9 8 3 ) w a s c o n s i s t e n t w i th s tr o n g r i g h t h a n d d o m i -na nc e (2 0 ou t of 24 poss ible po in ts ) . Both of the pa t ien t 's bro the rs a re r igh t han de d ,as a re bo th pa ren ts , bo th se ts of g ran dp aren ts , and h is au n ts and un c les . Becauseh is aphas ia p resen ted on ly subsequen t to h i s su rge ry and pe rs i s ted for 8 mon ths ,l a n g u a g e defici ts were n o t a t t r ibu table to r e m o te m a s s effect on left h e m i s p h e r es t ruc tures .F igure 4 depic ts the patient's r a t ing p rof i le of speech charac te r i s tic s , and F igu re5 reflects subtest profi les o n t h e Bo s to n D ia g n o s t i c A p h a s i a E x a m in a t i o n ( B D A E ;Goodglass & K a p l a n , 1 9 8 3 ) for the 5 - m o n t h a n d 9 - m o n t h e x a m i n a t i o n s . T h epatient also was examined with the M u l t i l i n g u a l A p h a s i a E x a m in a t i o n (M A E ;Be n to n & H a m s h e r , 1 9 8 3 ) a n d t h e Bo ston N a m in g T es t (K a p l a n , Goodglass, &W e in t r a u b , 1 9 8 3 ) .L a n g u a g e e v a l u a t i o n in April 1986 ref lec ted f l uen t , wel l -a r t icu l a ted spon ta-n e o u s s p e ec h , w i th m in im a l p a r a p h a s i c errors, b u t o b v io u s w o r d - fi n d in g p r o b l e m sand express ive sen tence form ula t ion difficult ies. C o m p r e h e n s io n g e n e r a l ly w a sgood , l imi ted on ly by verba l memory defici t . Repe t i t ion wa s im p a i r e d m i l d l y o nf orma l tes t ing re la t ive to norm al subjec ts (M A E Sen tence Re pe t i t ion subtest = 1 s tpe rcen t i l e a n d Digi t Repe t i t ion = 7 t h percen t i l e ) , bu t above average re la t ive too t h e r aphas ic s on the B D A E fo r repet i t ion ski ll s (see Figure 5) .

Formal testing reflected good language comprehension skills. In April 1986,p e r f o r m a n c e o n t he M A E T o k e n Test was a t t he 33rd percent i le re la t ive to n o r m a l s(9 1 + re la t ive to othe r aphas ic s ) , wi th M A E A u d i t o r y C o m p r e h e n s i o n o f W o r d sa n d P h r a s e s a t the 7 1 + percent i le re la t ive to normals (his perfec t score o f 1 8 / 1 8wa s a t the 9 1 + percen t i le re l a t ive to o the r aphas ic s ) . F igure 5 reflects his gooda u d i t o r y c o m p r e h e n s i o n o n t h e B D A E . R e a d i n g c o m p r e h e n s i o n g e n e r a ll y w a spreserved for the A p r i l a n d A u g u s t e x a m i n a t i o n s , a s reflected i n the B D A Ep e r f o r m a n c e . W r i t i n g p e r f o r m a n c e wa s variable o n t h e A p r i l e x a m i n a t i o n , im -p r o v in g to overa l l adequa te l eve l s o n t h e August te s t ing .T h r o u g h o u t b o th e x a m in a t i o n s , m o s t im p a i r e d p e r f o r m a n c e s w e r e o n meas-ures of n a m i n g and word-find ing abil i ty. On the M A E , V i s u a l N a m in g and


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Patient 's Name K.H. Da te o fR a t ed by

APHAS IA S E V E R I T Y R A T I N G SCALE0 No usable speech or auditory comprehension.1. All communication is through fragmentary expression; great need fo r inference,

questioning, and guessing by the listener. The range of information t h a t can beexchanged is limited, and the listener car r ies the burden of communication.

2. Conversation about familiar sub jec t s is possible with help from (h e listener. Thereare frequent failures to convey the idea, but patient shares the burden of commu-nication with the examiner.

f\ The patient can d i s cuss almost all everyday problems with little or no as s i s t an c e .Reduction of speech and/or comprehension, however, make s conversation aboutcertain material dif ficul t or impossible.

4. Some obvious loss of fluency in speech or facility of comprehension, without sig-nificant limitation on ideas expressed or form of expression.5. Minimal discernible speech handicaps; patient may have subjective diff iculties t h a t

ar e not apparent to listener.

RATING S C A L E PROFILE O F S PE E C H C H A R A C T E R I S T I C SMELODIC LINE

mtonaiional contour

PHRASE L E N G T Hlongestoccasionaluninterrupted

word runsA R T K T U L A T O R Y ACU I T Yfacility at phonemic and

syllable level

GRAMMA T I C A L FORMvariety o* grammaticalconstructions ieven PARAPH ASIA IN

RUNNING SPEECH

Rt PETITIONscore in High-Probability

subtest

WORD FINDINGinformational content m

relation to lluencv

AUDITORYCOMPREHENSIONmean of percentiles

on 4 Auditory Comprehension subtexts

a lways impairedor impossible

none available

present ineveryutterance

fluent withouttn orma t on

limrled toshort phrases andstereotypes

normal onlv m famihaiwords and phrases

limited to simplestereotypes

\ 1 1 1 1


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Crossed Aphasia 7 3

M U R I T ' l R A T I N G

HlfNO

COMPREHENSION

NAMING

ORAL READING

R E P E T I T I O N

PARAPHASIA

AUTOMATIC SPfECH

READINGCOMPREHENSION

WRITING

MUSIC

S P A T I A L AN DCOMPUTATIONAL

SUBTEST SUMMARY PROFILE^_ __Qf|i\[fNAMEP E R C E N T I L E S :

DATE OF EXAM:10 20 30 40 50 60 70 80 90 100

ARTICULATION RATINGPHRASf LENGTHMELODIC LINEV E R B A L A G I L I T YWORD DISCRIMINATIONBODY P A R T IDLNTIFK ATIONCOMMANDSCOMPLEX IDF.ATFONAI M A T E R I A L

,15S

RESPONSIVE NAMINGCONFRONTATION NAMINGANIMAL NAMING

54 3

WORD READINGORAL SENT(NC( READING

R S P E T I T I O N Of WORDSHIGH P R O B A B I L I T YLOW P R O B A B I L I T YNECHCX,ISTKL I T E R A LV E R B A LE X T E N D E D

4075

2 312

12185

ALTOMATIZED S E Q U E N C E SR E C I T I N GSYMBOL DISCRIMINATION 0WORD RECOGNITION 0( ()MPREHENSION OF ORAL S P E L L I N GWORD P IC T U R E MATCHINGREADING S E N T E N C E S AND PARAGRAPHSMECHANIC SS E R I A L WRITINGPR I M E R L E V E L DICTATIONS P E L L I N G TO DICTATIONW R I T T E N CONFRONTATION NAMINGS E N T E N C E S TO DICTATIONN A R R A T I V E WRITING

MNGINGRHYTHM

DRAWING TO COMMANDS T I C K M E M O R Y1 I) BUM hST O T A L F I N G E R SRIGHT lf TMAP ORIENTATIONA R I T H M E T I CC L ( KK S E T T I N G

0 10 I

0 b 70 ) 4

o :(1 >4 70i) 1 )( 1 J i

0 20 1 4

8 9 10fe 7 b4 S 6

81 93 1004 b 8b 9 114 8 11b 8

-9u97

10891149

12108

120It

1710

1311 1)9 10

130 14114 Ib1421 2 712

14

152

32

10 20 30 40 50 60 80 90 100Figure 5 . Bo sto n D ia g n o s t ic Ap h a s i a E x a m i n a t i o n s u bt es t profile. 5 m o n t h s a n d 9 m o n t h spostsurgery. The s u bt es t s u m m a r y profile is from The Assessment of Aphasia and RelatedDisorders, by H. Goodglass a n d E . K a p l a n . 1983. Malvern . PA: Lea & Febiger. Copyright1983 by Lea & Febiger. Reproduced by permiss ion .


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7 4 Glenn J. Larrabee et al.C on tro l led Oral W ord A ssocia t ion scores were a t less tha n the 1 s t percen t i le rela t iveto n o r m a l c o n t r o l s , and at the 4 2 n d and 40th percentiles, respectively, relative too ther aphas ics . On the Bos ton Naming Tes t , he ach ieved 62% cor rec t in Apr i l1986 a n d 5 7 % correct in A u g u s t 1 9 8 6.

T o s u m m a r i z e , t h e patient's speech pro f i le character is tics (Figure 4) andobjective l ang uage per fo rma nce were cons is ten t wi th a n a n o m i c a p h a s i a s y n d r o m e .C o m p a r i s o n of the A p r i l a n d A u g u s t B D A E e x a m i n a t i o n s r e fl e c ts s o m e i m p r o v e -m e n t i n s u b t e s t p e r f o r m a n c e s ( C o m m a n d s , C o m p l e x I d e a t i o n a l M a t e r i a l , A n i m a lN a m i n g , Sentences to Dic ta t ion , a nd N ar r a t ive W r i t ing ) . Overa l l, however , speechprof i l e cha rac te r i s t i cs a n d B o s t o n N a m i n g Test p e r f o r m a n c e reflect a rela t ivelys table p i c t u r e o f a n o m i c a p h a si a .Buccofa c ia l a n d i deomoto r p r ax i s were eva lua ted in Apr i l 1986 . W i th th eexcep t ion o f c o u g h i n g , b u c c o f a c i a l p r a x is wa s preserved (h e c o u l d d e m o n s t r a t eblow i ng o u t a m a t c h a n d s u c k i n g t h r o u g h a s tr a w ) . I d e o m o t o r p r a x is (r ig h t h a n do n l y was e x a m i n e d because of the left hemiparesis) was preserved for both intran-si t ive l i m b c o m m a n d s (wave good-by, beckon "come here ," and sa lu te ) andt r a n s i t ive l i m b c o m m a n d s ( br u sh y o u r t ee th , h a m m e r a na i l , a n d s a w a board ) . A llm o v e m e n t s w e r e a c c u r a t e l y a n d p r e c i s e l y p e r f o r m e d w i t h o u t a n y body-part-as-object errors.Spa t i a l , percep tua l , and cons t ruc t iona l per fo rmances were wel l -p reserved .The re was no ev idence o f any s ign i f ican t neg lec t o r hem ispa t i a l d i s to r t ion on l inebisect ion or r ep roduc t ion o f a Greek cross. Three Dimens iona l B lock Construction( B e n t o n , H a m s h e r , V a r n e y , & Spreen, 1983) wa s p e r f o r m e d p e r f e c t l y ( 2 9 / 2 9cor rec t ; 79+ percen t i le ) . I t i s no tewor thy tha t the th ree-d imens iona l models to becop ied by the pa t ien t were a ll placed i n the left h e m i s p a t i a l f ie ld by the e x a m i n e r .Ab i l i t y to d i s c r i m i n a t e a n d m a t c h s h a d e d p h o t o g r a p h s o f u n f a m i l i a r per sons (Fac ia lR e c o g n i t i o n Tes t ; Ben ton e t al. , 19 83) was 49 correct , a t the 8 5th percen t i le .J u d g m e n t of the a n g u l a r o r ie n t a t io n o f p a i r e d l i n e s t i m u l i ( J u d g m e n t o f L i n eO r i e n t a t i o n T e s t; B e n t o n e t al., 198 3 ) wa s 29/30 correct , a t the 86th percent i le .M o t o r a n d t ac t i l e f u n c t i o n s of the r igh t h a n d a ls o we re e x a m i n e d . T h e averagef inger t a p p i n g speed wa s 42.8 taps i n 10 s wi th the r igh t ind ex finger , a p er fo rma nc ea t the 1 9 t h p e r c e n t i le ( B o r n s t e i n , 198 5 ) . C o m p l e t i o n of the Grooved Pegboardr e qu i re d 9 1 s (8 th percen t i le ; Borns te in , 198 5 ) , a n d s t r eng th o f gr ip averaged 48 kg( 4 1 s t percen t i le , Borns te in , 1985) . The f i rs t t r ia l o n t h e P u r d u e P e g b o a r d wa s inth e i m p a i r e d r a n g e ( L e za k , 1 9 8 3) w i t h 1 1 pegs, whereas th e second t r i a l fell i n t hel o w - n o r m a l r ange wi th 13 pegs. Overall, r igh t h a n d m o t o r f u n c t i o n s w e re r e d u c e d ,p a r t i c u l a r l y o n m e a s u r e s of f ine mo tor de x te r i ty . Th is tes t ing a lso w a s c o n d u c t e d ,how e ve r , fo l lowing a full course o f r a d i o t h e r a p y , w h i c h c o u l d h a v e a c c o u n t e d fo rt h i s d e c l i n e in p e r f o rm a n c e . M a n u a l t a c t il e f u n c t i o n s we re p r e se r ve d fo r tact i lei den t i f i ca t ion of 1 0 out of 10 s a n d p a p e r g e o m e t r i c f o r m s on the Tact i le FormP e r c e p t i o n Tes t (Ben ton et al. , 198 3 ) . E a c h d e s i gn wa s i den t i f i ed r a p i d l y in 4 s , ona vera ge .M e m o r y f u n c t i o n i n g w a s var iab le , a n d ref lected mater ia l-specif ic def ici ts .O r i e n t a t i o n to t i m e w a s perfect , with zero errors o n t h e Tempora l Or ien ta t ion Test( B e n t o n et a l . , 1983) . Span o f dig i ts forward wa s a t t he 7 th p e r c e n t i le ( B e n t o n &H a m s h e r , 1983) .A s a n t i c i p a t e d , v e r b a l l e a r n i n g a n d m e m o r y wa s impa i red severe ly o n t h eV e rba l S e le c ti ve R e m i n d i n g T es t ( B u s c h k e , 1 9 7 3 ) . O ve r s ix tr ials, th e p a t i e n t wa sto t a l l y un ab l e to en te r words in to long- te rm s to rage ( r eca l l a word a t lea s t oncew i t h o u t r e m i n d i n g ) . C o n s e q u e n t ly , h e also w a s u n a b l e to cons i s ten t ly r e t r i eve


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Crossed Aphasia 7 5words . Both of these pe rf orma nces were be low the f i r s t pe rcen t i l e (Larrabee,Trahan, & L e v in . 1 9 8 6 ) .In c o n t r a s t , t h e p a t i e n t 's v i s u a l m e m o r y p e r f o r m a n c e w a s w e l l- p r e se r ve d . O nth e C o n t i n u o u s V i s u a l M e m o r y T e s t ( C V M T ; T r a h a n & Larrabee, 19 88) , wh ichrequi res de tec t ion of recu r r ing a bs tra c t v i sua l pa t t e rn s , s cores were a bove a vera gefo r d ' (62 nd pe rce n t i l e ) , t o t a l cor rec t (63rd pe rcen t i l e ) , a n d 3 0 - m i n d e l a y e dm u l t i p l e - c h o i c e r e c o g n i t i o n ( 9 0 t h p e r c e n t i le ) .R e c e n t a n d r e m o t e m e m o r y p e r f o r m a n c e w a s v a r ia b le fo r m e m o r y o f t h e la s ts ix U .S . p r e s i d e n t s ( H a m s h e r , 1 9 8 2 ) . w i t h th e va r i a b i l i t y c lose ly a s soc i a ted wi tht h e v e r b a l d e m a n d s of the t a sk . On the f i r s t t h ree subtes t s . pe rf orma nce w a s p o o r :Free Reca l l wa s f ou r of s ix (9 th percen t i le ) . V e r b a l O r d e r ( p l a c i n g c a r d s i m p r i n t e dwith t h e n a m e s o f t h e p r e s i d e n t s i n t h e c o r r e ct o r d e r o f office) wa s a t t he 9 thpe rcen t i l e , a n d P h o t o N a m i n g w a s fi v e o u t o f s i x ( 1 s t p e r c e n t i l e ) . O n t h e P h o t oN a m i n g subtes t , he showed obviou s diff icu l t ies s e co n d a r y t o a n o m i a . In a n a t t e m p tto n a m e Ronald Reagan, he replied, "He's now." Following this comment, he wasa g a i n asked to n a m e th e p i c t u r e o f R e a g a n a n d rep l i ed , "Yeah, b u t I R e a g a n . "H e w a s u n a b l e to n a m e a p i c t u r e o f Gera ld Ford . In a t t e m p t i n g t o d o t h i s , h ep o i n t e d to the tip of his t o n g u e and said, "It 's right here ." One flawless p e r f o r m a n c ew a s o n P h o t o S e q u e n c i n g . T h i s r e q u i r e d p l a c e m e n t o f p h o t o g r a p h s o f t h e l a s t s i xp r e s i d e n t s i n t he cor rec t o rde r o f office. It is n o t e w o r t h y t h a t t h i s p e r f o rm a n c e w a sbe t t e r t ha n th e a t t e m p t to s e q u e n c e p r i n t e d n a m e s of the pres iden t s , a ga in ref lec t ingt h e m a t e r i a l -s p e c i fi c n a t u r e o f t h e m e m o r y i m p a i r m e n t .T h e p a t i e n t ' s i n t e l l e c t u a l f u n c t i o n i n g w a s e v a l u a t e d w i t h th e W e c h s le r A d u l tIn t e l l i ge nc e Sca leRevised ( W A I S - R : W e c h s l e r, 1 9 8 1 ) . S u b t e st p e r f o r m a n c e s a red i sp la yed in Table 1 . The effects o f a n o m i c a p h a s i a o n m e a s u r e d i n t e l l e c t u a lf u n c t i o n i n g a re ev iden t , a s re f lec ted by the lower Verba l IQ of 7 5 , re l a t ive to theP e r fo r m a n c e I Q o f 9 2 . T h e P e r fo r m a n c e I Q o f 9 2 a l s o w a s l o w e r t h a n w o u l d b eexpected on the basis of his e d u c a t i o n a l b a c k g r o u n d . However , there a lso wascons ide ra ble Pe rf orma nce I Q subtes t var iabi l i ty , r a n g i n g f rom a low of the 5thpe rc e n t i l e f or the Dig i t Sym bol subtes t t o the 7 5 th pe rce n t i l e fo r P i c tu re C om ple t io n( w h i c h wa s pe rf orme d by po in t ing to the m is s ing objec t s on 13 of 1 8 cor rectresponses, because h e w a s f re q u e n t l y u n a b le to n a m e t h e m c o n s e q u e n t to thea n o m i a ; h e d id , however , re spond "snow on i t " to the 2 0 t h i t e m ) . I n t e r e s t i n g l y , h ep e r f o r m e d bes t when h e d i d n o t n e e d to m a k e a verba l re sponse a n d w h e n v e r ba lp r o c es si n g d e m a n d s w e re m i n i m a l ( P i c t u re C o m p l e t io n a n d Block Design subtes ts ) .A s v e r ba l p r o ce s si n g d e m a n d s i n c r e a s e d , perf orma nce de te r io ra t ed . Hence . Objec tA s s e m b l y , w h i c h m a k e s h i g h e r v e r b a l e n c o d i n g d e m a n d s t h a n B l o c k D e s i g n(La r ra bee . 198 6) . wa s p e r f o r m e d a t a l o w e r l e v e l . P i c t u r e A r r a n g e m e n t was thesecond poo res t pe rf orm a n ce . His poorest pe rf orm a n ce of a l l wa s on the Dig i tS y m b o l subtes t , wh ich requ i res g ra p hom otor cod ing o f s y m b o l s to n u m b e r s a n drequ i res l e a r n i n g a n e w s e ri es o f g r a p h e m e s .

DiscussionT h e p r e s e n t c a s e p r o v i d e s s t r o n g e v i d e n c e f o r m e d i a t i o n o f l a n g u a g e a n d v e r b a lm e m o r y f u n c t i o n s b y th e r i g h t h e m i sp h e r e a n d s p ati al a n d v is u a l m e m o r y f u n c t i o n sby th e left h e m i s p h e r e in a s t rong ly r igh t h a n d d o m i n a n t m a l e . T h e pa t i en t ' s goodspa t ia l abi l i t ies a re d e m o n s t r a t e d by p e r f o r m a n c e s o n t h e J u d g m e n t o f L i n eOrien t a t ion Tes t , Three Dimens iona l Block Construction, a n d t h e W A I S - R B l o ckDesign , a n d g o o d v is u a l m e m o r y ( C o n t i n u o u s V i s u a l M e m o r y T e s t) c o n t r a s te d


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76 Glenn J. Larrabce el a/ .Table 1P e r f o r m a n c e o n W e c h s l e r A d u l t I n t e l l i g e n c eScale-Revised

Scaled A ge ScoreSubt e s t sc o re sc a le d pe rc e n t i l eI n f o r m a t i o nDigit SpanV o c a b u l a r yA r i t h m e t i cC o m p r e h e n s i o nS i mi l a r i t i e sP i c t u r e C o m p l e t i o nP i c tu r e A r ra n g e m e n tBlock DesignO bje c t Asse m blyD ig i t Sym bol

156154

1 281 194

6567541 281 195

95916527 52 563375

w i t h a n o m i a a n d v e r b a l m e m o r y i m p a i r m e n t . T h is m oda l i ty - spec i f ic p a t t e r n a r g u e sa g a i n s t a n a l t e rn a t i v e h y p o t h e s i s o f n o n - la n g u a g e -b a se d w o r d - fi n d i n g i m p a i r m e n ts e c o n d a r y to g e n e r a li ze d " a d y n a m i a " w i t h r e d u c ed a r o u s a l a n d c o r t i c a l t oner e s u l t i n g f rom a d e e p , f r o n t o s u b c o r t i c a l les ion (cf . Lur ia , 198 0 ) . S u c h a n a d y n a m i aw o u l d be e xpe c t e d t o have a ge ne ra l i ze d effect o n v e r b a l a n d n o n v e r b a l f u n c t i o n s ,r a t h e r t h a n a m o d a l i t y - s p e c i f i c effect ( C r o s so n . 1 9 8 4 ) . M o r e o v e r , a l t h o u g h t h i sm a n h a d r e d u c e d p e r fo r m a n c e o n P i c tu r e A r r a n g e m e n t c o m p a r e d w i t h B l o c kD e s i gn , w h i c h h a s been observed fo l lo w i n g r i gh t a n t e r i o r te m p o r a l l e s io n s ( M e i e r& F r e n c h . 1966; R e i t a n . 195 5 ) . t h i s i s no t a v i a b le e x p l a n a t i o n for the c u r re n t t e s tp e r f o r m a n c e p a t t e rn w h e n o n e c o n s id e r s t h e m o d a l i t y -s p e c i fi c m e m o r y i m p a i r -m e n t . I n d e e d , v i su a l m e m o r y fo l lowing r i g h t a n t e r i o r t e m p o r a l l o b e c t o m y w a sabove average, c on t ra s t e d to s e ve r e ly im p a i r e d v e rb a l m e m o r y skil ls . C o n s e q u e n t l y ,his r e duc e d P i c t u re A r ran ge m e n t r e la t i ve t o B loc k D e si gn i s bes t e xp la i ne d by t helower verbal processing demands of the Block Design subtest (Larrabee, 1986) .T h e c u r r e n t case, w h i c h c l e a r l y p r e s e n t e d a s a n a n o m i c a p h a s i a , p r o v i d e sf u r t h e r suppor t t ha t c rosse d aphas i a syndrome s pa ra l l e l t hose se e n w i t h left h e m i -s p h e r e la n g u a g e s y n d r o m e s . I n r e fe r e n c e t o t h e B o s to n V e t e r a n s A d m i n i s t r a t i o nH o s p i t a l a p h a s i a c l a s s i f ic a t i o n s c h e m e ( B e n s o n . 1985) , th e fo l lo w i n g s y n d r o m e sh a v e been observed in c rosse d apha s i a : We rn i c ke aph as i a ( B asso e t al . , 1985:C a s t ro -C a ldas & C on f ra r ia , 1984 : H e nd e rson . 1983: Sw e et . P an i s , & L e v ine . 198 4 ) .B roc a aphas i a ( B asso et a l . . 198 5 : C as t ro - C a ldas & C onfra r i a , 1984 : Carr et a l . .1 9 8 1 ) . c o n d u c t i o n a p h a s i a ( C a s tr o -C a l d a s & C o n f r a r ia . 1984; H a a l a n d & M i r a n d a .1 9 8 2 : H e n d e r s o n , 1 9 8 3 ) . t r a n s c o r t i c a l a p h a s i a ( C a r r e t al.. 1 9 8 1 : C a s t r o - C a l d a s &C o n f r a r i a . 1 9 8 4 ) . a n o m i c a p h a s i a ( p re s e n t case) , g loba l aphas i a ( C ar r et a l . . 1 9 8 1 ) .a n d subcortical aphas i a ( H abi b e t al., 1983: Sapi r e t al.. 198 6) . T h e fact t h a t a l l oft h e m a j o r left he mi sphe re aphas i c syndrome s a l so have be e n re po r t e d i n c ase s o fc rosse d apha s i a s t rong ly a rgue s aga i ns t B row n a n d W i l s o n ' s ( 1 9 7 3 ) t he s i s t ha t t he reis a u n i q u e l a n g u a g e s y n d r o m e c h a r a c t e ri s ti c o f c rosse d aphas i a .T h e pre se n t case also s u p p o r t s th e t he o re t i c a l c ons t ruc t o f r e ve rsed l a t e ra l i t y ,with th e e xc e p t i on of the c u r re n t pa t i e n t ' s p re se rve d i de omot o r p rax i s . F o r l a t e ra l i t y


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Crossed Aphasia 7 7to he t r u l y "reversed." pra x i s a l so shou ld be g o v e r n e d by the r i g h t h e m i s p h e r e .J u n q u e et a l . ( 1 9 8 6 ) suggested that true reversed l a t e ra l i t y c a n o n l y b e m a n i f e s t e din t he s i tua t ion where a left h a n d d o m i n a n t i n d i v i d u a l ha s speech a n d p ra x i sg o v e r n e d by the r igh t h e m i s p h e r e a n d s p a t i a l f u n c t i o n s m e d i a t e d by the l e f t . Thesea u t h o r s c it e th e case rep or t ed by Delis. K n i g h t , a n d S i m p s o n ( 1 9 8 3 ) a s a n e x a m p l eo f t ru e reversed l a t e r a l i t y . I n con t ra s t. Ju n qu e e t a l . ( 1 9 8 6 ) n o t e d t h a t a c o m p l e t ei n v e r s i o n o f n e u r o p s y c h o l o g i c a l f u n c t i o n s , i n c l u d i n g p r a x i s , h a s n e v e r b ee n r e -por ted i n dex t ra l s .T h e presence o f preserved l i m b p r a x i s i n the c u r r e n t c a s e s u p p o r t s p r e v i o u sd a t a s u g g e s t i n g t h a t p r a x i s is g o v e r n e d by the h e m i s p h e r e c o n t r a l a t e r a l to thed o m i n a n t h a n d ( B r o w n & W i l s o n . 1 9 7 3 : H a a l a n d & M i r a n d a . 1 9 8 2 : J u n q u e e t a l ..1986: K a p u r & D u n k l e y . 1984: Larrabee e t al . . 1 9 8 2 ) . A l t h o u g h t h i s w o u l d s ug g es ta n i n v a r i a n t p a t te r n o f ce rebra l represen t a t ion o f praxis ( i .e . . a lways representedby t h e h e m i s p h e r e c o n t r a l a t e ra l to t h e d o m i n a n t h a n d ) , the cases reported by Bassoe t a l . ( 1 9 8 5 ) a n d H e n d e r s o n ( 1 9 8 3 ) d o c u m e n t t h a t a p r a x i a c a n r e s u l t f r o m r i g h th e m i s p h e r e l e s ions i n r i g h t - h a n d e d crossed a p h a s i c i n d i v i d u a l s , a l t h o u g h t h i sa p p a r e n t l y i s a mu ch le ss f requ en t occur renc e i n c ros sed a pha s i a .T h e o b s e r va t i o n b y J u n q u e a n d c o l le a g u e s ( 1 9 8 6 ) t ha t t rue reversed l a t e r a l i t yo n l y o c c u r s in l e f t -h a n d e r s w i t h r i g h t h e m i s p h e r e s p e e c h r e p r e s e n t a t i o n , a n d t h eda ta of Basso e t a l . ( 1 9 8 5 ) a n d H e n d e r s o n ( 1 9 8 3 ) d o c u m e n t i n g t h a t p r a x i s c a n b ei m p a i r e d in crossed a p h a s i a , suppor t a complex pa t t e rn of the va r i e t i e s of ce rebra lh e m i s p h e r i c represen t a t ion of neu ropsyc holog ica l f u n c t i o n s . A s n o te d b y J u n q u ee t a l . ( 1 9 8 6 ) . th e va r i a b i l i t y o f l a t e r a l i z a t i o n o f f u n c t i o n s is u n d e r s c o r e d f u r t h e r bys t u d i e s repo r t i ng spa t i a l de f i c i t s i n c ros sed a p ha s i a (Ba sso e t al.. 1985: Ca r r e t al . .1 9 8 1 : Cla rke & Zangwil l . 1965: Haa land & M i r a n d a . 1982: Hend erson. 19 83) .T h e c o m p l e x i t y o f l a t e r a l i z a t i o n o f n e u r o p s y c h o l o g i c a l f u n c t i o n s wa s addressedsevera l yea rs a go in a n a r t i c le by Kre ind le r . F ra d i s . a nd Seva s topo l ( 1 9 6 6 ) . Thesea u t h o r s proposed e igh t t ypes o f h e m i s p h e r i c o r g a n i z a t io n ( f ou r f or r igh t -ha ndersa n d t h e converse o f these fo r l e f t - h a n d e r s ) : (a ) l a n g u a g e i n t he l e f t h e m i s p h e r e ,spa t i a l in the r ight : (b) l a n g u a g e i n t he r i gh t h e m i s p h e r e , spa t i a l in t h e . l e f t : (c )l a n g u a g e a nd spa t i a l i n the left h e m i s p h e r e : a n d ( d ) l a n g u a g e a n d s p a ti a l i n t h er i g h t h e m i s p h e r e . T h e second type o f ce rebra l l a t e ra l i za t ion would cor respond tomost cases of r igh t h a n d d o m i n a n t crossed a pha s i a ( spa t i a l a n d d o m i n a n t h a n dr e p r e s e n t a t i o n i n t he l e f t h e m i s p h e r e a n d l a n g u a g e r e p r e s e n t e d i n t he r i gh t -h e m i s p h e r e i n a r i g h t - h a n d e r ) . J u n q u e e t a l.'s ( 1 9 8 6 ) "true" reversed l a t e r a l i t y ( t h ecase o f Del i s e t al . . 198 3 ) w o u l d c o r r e sp o n d to K r e i n d l e r e t al . 's ( 1 9 6 6 ) l a t e r a l i t yp a t t e r n for a l e f t - h a n d e r , o f spa t i a l f unc t ions represen ted i n t he l e f t h e m i s p h e r ea n d l a n g u a g e a n d d o m i n a n t h a n d c o n t r o l r e p r e s e n t e d by the r igh t h e m i s p h e r e .

It is n o t e w o r t h y t h a t l a t e r a l i t y o f pra x i s , or the c o n t r o l o f ski l led m e a n i n g f u lh a n d m o v e m e n t s , w a s n o t addressed by Kre ind le r e t a l . ( 1 9 6 6 ) . A l t h o u g h , a s n o t e d ,t h e m a j o r i t y o f r ig h t - h a n d e r s w i t h b o th t y p i c a l h e m i s p h e r e d o m i n a n c e a n d c ro ss eda p h a s i a a p p e a r to ha ve pra x i s con t ro l l ed by the h e m i s p h e r e c o n t r a l a t e r a l to thed o m i n a n t h a n d , o t h e r r e p r e s e n t a t i o n s c a n o c c u r i n w h i c h p r a x i s c a n b e g o v e r n e dby th e l a n g u a g e d o m i n a n t h e m i s p h e r e ( Ba ss o et a l . . 1 9 8 5 : H e n d e r s o n . 1983) .A l t h o u g h t h i s raises th e ques t ion of the possible exis tence of one h e m i s p h e rer e p r e s e n t i n g b a s i c m a n u a l d o m i n a n c e , w i t h th e o t h e r h e m i s p h e r e r e p r e s e n t i n gl a n g u a g e , spa t ia l , a n d i deom otor p ra x i s a b i li ti e s . Basso et a l . ( 1 9 8 5 ) reported t h r e ecases o f crossed a pha s i a w i th a dd i t iona l spa t i a l de f i c i t s w h o d i d n o t h a v e a c c o m -p a n y i n g i deomotor a pra x ia .In clos ing, the p resen t case s tudy is of in teres t in severa l respects . First, it


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7 8 Glenn J. Larrabee el al.provides f u r t h e r evidence to accompany the growing body of literature document-in g that language syndromes in crossed aphasia parallel those seen in left hemi-sphere aphasic syndromes. Additionally, it documents that a f r e q u e n t hemisphericrepresentation of f u n c t i o n in right-handed dominant crossed aphasia is one favor ingcontrol of spatial functions and praxisby the left hemisphere. Finally, the exceptionsto this f r e q u e n t pattern of representation of f u n c t i o n s in crossed aphasia underscorethe complexity of cerebral lateralization of f u n c t i o n s in general, and support morecomplex models of l a t e r a l i z a t i o n of f u n c t i o n s such as the one proposed by Kreindleretal. ( 1 9 6 6 ) .

ReferencesBasso. A., C ap i t an i , E ., Laiacona . M.. & Z an o b i o . M . E . ( 1 9 8 5 ) . Crossed aphasia: One o rm o r e s y n d r o m e s ? Cortex. 21 . 25-45.B e n so n . D.F. ( 1 9 8 5 ) . A p h a s i a . In K . M . H e i lm a n & E . V a l e n s t e i n (Eds. ) . Clinical neuropsy-chology ( 2 n d e d .. p p . 17 -47 ) . N ew Yo rk: Oxford Unive rs i ty Press.B e n t o n , A.L., & Hamsher . K. deS. (1983) . Multilingual Aphasia Examination. Iowa Ci ty .IA : AJA Associates , Inc .B e n t o n . A.L. . Hamsher , K. deS., Var n e y . N . R . . & Sp r e e n . O. ( 1 9 8 3 ) . Contributions toneuropsychological assessment: A clinical man ual. N ew Y o r k : Oxford Un ivers i ty P ress.Borns te in , R . (1985) . N o r m a t i v e d a ta o n se lec ted neuropsycho log ica l measures in a n o n c l i n -ical sample . Journal of Clinical Psychology. 41 . 651-659 .Brown. J .W. . & Wilson . F .R. ( 1 9 7 3 ) . Crossed aphasia in a d e x t r a l . A case report . Neurologv.2J. 9 0 7 - 9 1 1 .Busc hke , H. ( 1 9 7 3 ) . Se l ec t iv e r e m i n d i n g fo r a n a l y s i s of m e m o r y a n d l e a r n i n g . Journal of

Verbal Learning and Verbal Behavior. 1 2. 543-550.Ca rr , M .S. , Jacobson. T., & Boi ler . F . ( 1 9 8 1 ) . Crossed ap has i a : Ana lys i s of four cases. Brainand Language, 1 4 . 190-202 .Cast ro-Caldas . A.. & Confra r ia , A. ( 1 9 8 4 ) . A g e a n d type of crossed aphasia in d e x t r a l s d u eto s t roke . Brain and Language. 23. 12 6 -133 .Clarke. B. , & Zangwi l l , O. L. ( 1 9 6 5 ) . A case o f "crossed aphasia" in a d e x t r a l . Neuropsy-cho/ogia,3.Sl-86.Crosson. B. ( 1 9 8 4 ) . R o l e of the d o m i n a n t t h a l a m u s in l an g u ag e : A review. PsychologicalBulletin, 96. 4 9 1 - 5 1 7 .Delis. D.C.. K n i g h t . R.T.. & Simpson. G. ( 1 9 8 3 ) . Reversed hemispher i c o rganiza t ion in al e f t -hande r . Neuropsychologia. 21 . 13-24.

Goodglass. H.. & K a p l a n . E . (1983) . The assessment of aphasia and related disorders ( 2 n ded . ) . P h i l a d e l p h i a ,PA: Lea & Febiger.H a a l a n d , K. Y . , & M i r an d a . F . ( 1 9 8 2 ) . Ps y c h o m e t ri c an d C T s can m e a s u r e m e n t s i n a c a seof crossed aphasia in a dextral . Brain and Language, 1 7 , 240-260.Habib, M.. Joanet te . Y ., Ali-Cherif . A.. & Po n c e t , M . ( 1 9 8 3 ) . Crossed aphas i a in dex t ra l s : Acase report with special reference to site of les ion . Neuropsychologia. 21 . 4 1 3 - 4 1 8 .Ha m sh e r , K . ( 1 9 8 1 ) . In t e l l i gence a n d aphas i a . In M.T. Sarno ( E d . ) . Acquired aphasia (pp .3 2 7 - 3 5 9 ) . N ew Yo rk: Acad emic Press .H a m s h e r , K. ( 1 9 8 2 ) . Presidents Test. Manual of instructions. M i l w au k e e . D e p a r t m e n t ofN e u ro l o g y , U n i v e r s i t y o f W iscons in Med ica l Schoo l .Hecaen , H., Mazars , G.. R am i e r , A., G o l d b l u m , M . . & M e r i e n n e . L. ( 1 9 7 1 ) . A p h a s i e croisseechez un sujet droit ier bi l ingue (vie tnamien-francais ) [Crossed aphas ia in a r igh t-handedb i l i n gua l subject (Vie tnamese-French ) ] . Revue Neurologique, 1 24. 319-323 .H e n d e r s o n , V . W . ( 1 9 8 3 ) . Speech fluency in crossed aph asia. Brain. 106. 837-857,Jud d, T . (1989 ) . Crossed " righ t hemisphere syn drom e" wi th l i m b aprax ia : A case s tudy .Neuropsychology. 3 . 1 5 9 - 1 7 3 .


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Crossed Aphasia 79J u n q u e , C. . L i tvan , I. , & V e n d r e l l, P . (1986) . Does reversed laterali ty really exist in dextrals?A case s tudy. Neuropsychologia, 24, 2 4 1 - 2 5 4 .K a p l a n , E ., Goodglass, H., & Wein t raub , S. ( 1 9 8 3 ) . The Boston Naming Test . Boston: Leaand Febiger .Kap ur , N., & Dunkley, B. (1984) . Neuropsychological analysis of a case of crossed dysphasiaverified a t pos tmor tem. Brain and Language, 23 , 134-147.Kre indle r , A., Fradis, A., & Sevastopol, N . (1966) . La repar t i t ion d es d o m i n an c e s h e m i s p h e -riques [The distribution of hemisphere d o m i n a n c e ] . Neuropsychologia, 4 , 143-149.Larrabee. G.J . (1986) . Ano ther look a t V IQ P IQ scores a n d uni l a t e ra l b ra in damage .International Journal of Neuroscience, 29, 141-148.Larrabee, G.J., Kane. R.L. , & Rodgers , J .A. ( 1 9 8 2 ) . Neuropsychological analys is of a caseof crossed aphasia: Implicat ions fo r reversed laterali ty. Journal of Clinical Neuropsy-chology,4. 1 3 1 - 1 4 2 .Larrabee, G.J., Trahan , D.E . , & Levin, H.S. (1986, February) . Normative data for the verbalselective reminding test. P ape r presented at the 14th A n n u a l M e et in g of the I n t e r n a t i o n a lN e u ro p sy c h o l o g i c a l Society, Denver. C O.Lezak, M.D. ( 1 9 8 3 ) . Neuropsychological assessment ( 2 n d e d .) . N ew York: Oxford Univers i tyPress.Lur ia , A.R. (1980) . Higher cortical functions in man ( 2 n d ed.) . New Y ork: Basic Books.Meier , M.J.. & French, L.A. (1966). Longitudinal assessment o f intel lectual func t ion ingfol lowing uni l a t e ra l t empora l lobectomy. Journal of Clinical Psychology, 22, 22-27.Podbros, L.Z., & DePiero , T.J. (1985, February) . Absence of aphasia and presence of "righthemisphere signs" in a right-hander with significant l e f t hemisphere damage: A case fo rreversed laterality? Paper presented at the 13th A n n u a l M e e ti n g of the In te rna t iona lNeuropsychological Socie ty, San Diego, C A .R e i t a n , R . M . ( 1 9 5 5 ) . Cer t a in differential effects o f left and r igh t cerebral lesions in h u m a nadul ts . Journal of Comparative and Physiological Psychology, 48, 474-477.Roberts, L. ( 1 9 6 9 ) . Aph asia, apra xia and ag nosia in abnorma l s tates of cerebral dom inan ce.In P.J. V ink en & G.W. B ru y n (Eds. ) , Handbook of clinical neurology (Vo l . 4 . pp. 312-325) . A m s t e r d am : N o r t h H o l l an d .Sapir . S. , Kokmen. E. . & Rogers , P.J . (1986). Subcort ical crossed a pha sia: A case report .Journal of Speech and Hearing Disorders, 51 . 1 7 2 - 1 7 6 .Sweet, E.W .S., Panis . W ., & Levin e, D.N. (1984) . Crossed Wernicke 's aphasia. Neurology.3 4 , 4 7 5 - 4 7 9 .Taylor . H.G., & Solomon, J .R. ( 1 9 7 9 ) . Reversed lateral i ty: A case s tudy . Journal of ClinicalNeuropsychology, 1 , 3 1 1 - 3 2 2 .Trahan. D.E. , & Larrabee, G.J. (1988) . The Continuous Visual Memory Test manual .Odessa, F L: Psychological Assessment Resources.Wechsler . D. ( 1 9 8 1 ) . Manual fo r the Wech sler Adult Intelligence ScaleRevised. New York :T h e Psychological Corporat ion.

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