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From the Departments of Neurology (Drs. Loring and Meador), Psychiatry and Surgery (Neurosurgery) (Dr. Lee), Medical College of Georgia, Augusta; Department of Psychology (Dr. Strauss), University of Victoria, British Columbia; Department of Neurology (Dr. Hermann), University of Wisconsin, Madison; Department of Neurology (Dr. Perrine), New York University; Department of Psychology (Dr. Trenerry), Mayo Clinic Foundation, Rochester, MN; Department of Psychology (Dr. Barr), Long Island Jewish Hospital, Glen Oaks, NY; Department of Neurosurgery (Dr. Westerveld), Yale University, New Haven, CT; and Department of Neurology (Dr. Chelune), Cleveland Clinic Foundation.
Address correspondence and reprint requests to Dr. David W. Loring, Department of Neurology, Medical College of Georgia, Augusta, GA 30912-3275.
OBJECTIVE: To examine the effects of anomalous language representation (i.e., mixed- and right-cerebral dominant) on neuropsychological performance.
BACKGROUND: Right cerebral language dominance resulting from early cerebral injury is associated with relatively preserved language function with decreased visuospatial ability. However, previous reports of this phenomenon have examined patients with relatively large cerebral injuries (e.g., infantile hemiplegia) or limited sample sizes.
METHODS: A total of 561 patients with complex partial seizures of left temporal lobe origin were studied. Patients were classified into left (n = 455), bilateral (n = 58), and right (n = 48) language dominant groups based on Wada testing.
RESULTS: Right language dominant patients performed more poorly on multiple tests of visuospatial function, including Performance IQ (PIQ), than did left language patients. No significant group differences were detected for measures of language or general verbal function. The effects of bilateral language on PIQ differed according to handedness. Lowered PIQ was present in the bilateral nondextral group but not for bilateral dextral patients, and this pattern was observed with other visuospatial measures.
CONCLUSIONS: In patients with relatively small lesions restricted to the left mesial temporal lobe, a shift in language dominance to the right hemisphere is associated with decreased visuospatial functions but preserved verbal abilities. Nondextral patients with bilateral language representation also displayed decreased visuospatial performance, although dextral patients with bilateral language did not.
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