The history of crossed aphasia: early development of concepts and hypotheses

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Abstract

As an exception to so-called Broca's doctrine, assigning left-hemisphere dominance for language to dextrals and right-hemisphere dominance for language to sinistrals, Byrom Bramwell introduced, more than a century ago, the term crossed aphasia (CA) to denote the exceptional condition in which an aphasic syndrome results from a cerebral lesion ipsilateral to the dominant hand. Bramwell assumed that, in contrast to temporary manifestations, persistent CA is rare and essentially limited to the sinistral population. During the next decades, however, this view was challenged by several studies that reported persistent CA in dextrals (CAD). The initial concept of CA further eroded when studies on aphasia in sinistrals showed that CA is the rule and not the exception in this population. This paper reviews the early development and erosion of concepts in CA.

Section snippets

The introduction of a new concept called ‘crossed aphasia’

As an exception to so-called Broca's dogma which established left hemisphere language dominance in right-handers and right hemisphere language dominance in left-handers, Byrom Bramwell (1847–1931) introduced in 1899 the concept of crossed aphasia (CA). Bramwell (1899) defined as such the phenomenon of aphasia caused by brain damage ipsilateral to the dominant hand. He documented the concept with a thorough description of a 36-year-old left-handed male who still presented important expressive

Initial evidence against the standard views

In line with Bramwell's observations (1899), several additional cases of crossed aphasia in sinistrals (CAS) were reported during the first few decades of the 20th century (Ardin-Delteil et al., 1923, Chester, 1936, Leipmann, 1912, Long, 1913, Miyake, 88, Tilney, 1936, Weisenburg and McBride, 1935). Within this group of early observations, the reports of Leipmann, 1912, Long, 1913 particularly challenged the classical views on aphasia in sinistrals by contradicting expected anatomoclinical

Hidden sinistrality

In an effort to sustain the integrity of the dogma of cerebral dominance for language, most authors at the beginning of the 20th century reduced CAD to an artifact. The right-hand preference of patients with CAD was often identified as an artificial effect, due to social and educational correction of congenital left-handedness. Terms such as the English ‘hidden sinistrality’, the French ‘gaucher corrigé’ and the German ‘verkappten Linkser’ were used to indicate the so-called hidden forms of

Conclusions

The insights regarding the ‘gaucherie cérébrale’ and the dogma of an inherent correlation between hand preference and cerebral dominance for language played a crucial role in the formation of the CA concept. Bramwell (1899) united clinical exceptions to these insights in the CA concept at the end of the 19th century and explained the phenomenon on the basis of three causal factors: (1) genetically determined transfer of cerebral dominance for language; (2) congenital, natural hand preference;

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