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(Stroke. 2002;33:1749.)
© 2002 American Heart Association, Inc.

Letters to the Editor

Crossed Nonaphasia in a Dextral With Left Hemispheric Lesions: Handedness Technically Defined

Iraj Derakhshan, MD

Charleston, West Virginia

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

The article by Hund-Georgiadis et al on crossed nonaphasia in a "dextral" with left hemispheric lesion¹ deserves attention because of the light it and similar cases throw on the subject of laterality and hemispheric dominance in humans. However, this requires abandoning certain conventionalism, which is the cause of the puzzlement they expressed as to the laterality of the results they obtained, ie, ipsilateral activity of motor cortex on moving the ostensibly dominant hand (as opposed to the neurologically dominant, as I explain below). In this light, their result is a reaffirmation of the findings of high-resolution EEG experiments of Kristeva et al,^2,3 Barrett et al,⁴ and others.⁵ More recently, similar observation has been made using functional MRI,^6,7 positron-emission tomography,⁸ transcranial magnetic stimulation,^9,10 and Doppler¹¹ techniques. These observations require an anatomical substrate, depicted below.

One source of confusion of the respectable authors is their complete reliance on an inventory-based methodology in ascertaining a subject’s laterality. The other is lack of appreciation of the anatomical significance of absence of apraxia in the subject’s (ostensibly nondominant) left hand. Cognizance of these 2 critical points as well as intimate familiarity with 2 other laterality indexed clinical syndromes are essential ingredients in grasping the issues involved.

The twin entities to which I referred are syndromes of ipsilateral weakness involving the nondominant hand in certain lesions affecting the dominant hemisphere,^12,13 and that of weakness involving nondominant hand after callosotomy, whether natural (such as in Marchiafava-Bignami disease or trauma)^14–16 or iatrogenic¹⁷ (and my own unpublished data). The . . . [Full Text of this Article]

Margret Hund-Georgiadis, MD D. Yves von Cramon, MD, PhD

Max-Planck-Institute of Cognitive Neuroscience, Leipzig, Germany

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