A case of crossed aphasia with persistent language disturbances in a right-handed boy aged 5 yr 9 mos is reported from the Centre Hospitalier Universitaire Vaudois, Lausanne, France. An acute left hemiplegia resulted from occlusion of the internal carotid siphon of undermined cause and demonstrated by arteriography. The boy was mute, his auditory comprehension impaired, and tongue and facial movements apraxic. His first intelligible words (maman and non) were pronounced at 2 months after the onset. The language remained agrammatic and the vocabulary and comprehension poor but the tongue apraxia resolved. Twelve years later, language disturbances were still present although his IQ on the WAIS was 100 full scale, 86 verbal (information 6, comprehension 6, digit memory 5, vocabulary 7, arithmetic 8) and 116 performance scale.

The CT scan showed an atrophic right hemisphere and dilated lateral ventricle with cortical and subcortical low densities involving the base of the 3rd frontal, supramarginal, insular and middle part of 1st temporal convolutions, the lecticular and caudate nuclei and the anterior limb of the internal capsule. [1]

COMMENT: Crossed aphasia is the combination of right hemiparesis with aphasia in a left-handed patient or left hemiparesis and aphasia in a right-handed patient. It is rare in dextrals, only 9 cases cited in a review article by Brown JW and Hecaen H [2]. Diagnosis requires the following: a pathologic lesion limited to the right hemisphere, absence of early childhood brain damage, strong right-handedness, and a negative family history of left-handedness. These criteria were satisfied in the author’s case. A state of incomplete left lateralization is suggested to explain crossed aphasia in a right-handed patient. Although recovery of fluency is quicker and more extensive than in adults, later academic problems are common in children with aphasia even with those caused by left hemisphere lesions. [3]