The role of the right hemispheric homologous language pathways in recovery from post-stroke aphasia: A systematic review.

The involvement of the right hemisphere, mainly the activation of the right cerebral regions, in recovery from post-stroke aphasia has been widely recognized. In contrast, the role of the right white matter pathways in the recovery from post-stroke aphasia is rarely understood. In this study, we aimed to provide a primary overview of the correlation between the structural integrity of the right hemispheric neural tracts based on the dual-stream model of language organization and recovery from post-stroke aphasia by systematically reviewing prior longitudinal interventional studies. By searching electronic databases for relevant studies according to a standard protocol, a total of 10 records (seven group studies and three case studies) including 79 participants were finally included. After comprehensively analyzing these studies and reviewing the literature, although no definite correlation was found between the right hemispheric neural tracts and recovery from post-stroke aphasia, our review provideds a new perspective for investigating the linguistic role of the right hemispheric neural tracts. This suggests that the involvement of the right hemispheric neural tracts in recovery from post-stroke aphasia may be mediated by multiple factors; thus, this topic should be comprehensively investigated in the future.

EXPRESS: Hemispheric Asymmetry for Global-Local Processing: Effects of Stimulus Category and Ageing.

Hemispheric asymmetry has been reported for global-local processing in young and older adults, with global processing specialised in the right hemisphere (RH-global specialisation) and local processing specialised in the left hemisphere (LH-local specialisation). Questions persist regarding the extent to which hemispheric asymmetry is influenced by stimulus category (verbal stimuli processed in the left hemisphere; visuospatial stimuli processed in the right hemisphere). Some evidence suggests stimulus category does not influence hemispheric asymmetry (stimulus-independent account) while other evidence suggests it does (stimulus-dependent account). In older adults, there was evidence of a local-processing advantage, believed to result from slower and less accurate performance in right-hemisphere compared to left-hemisphere functioning-the right-hemisphere ageing hypothesis. We examined hemispheric asymmetry for global-local processing in young and older participants with three hierarchical figures (letters, verbalisable objects, nonverbalisable shapes), in a within-subjects design using a divided-attention paradigm and unilateral presentation. Our findings for letters and verbalisable objects support the stimulus-independent account-young and older participants demonstrated RH-global specialisation and LH-local specialisation regardless of stimulus category. In older participants, we also found a local-processing advantage for all three stimulus categories-an advantage best explained as faster and more accurate performance in local processing regardless of the visual field of stimulus presentation. Overall, we found hemispheric asymmetry for global-local processing in both young and older adults, and differences in global processing between young and older adults. Future investigation is suggested for the hemispheric asymmetry found in global-local processing of nonverbalisable shapes, and the mechanisms underlying age-related changes in global processing.

Separated at birth: Rediscovering the lost emotions in Luria's Working Brain.

Aleksandr Luria repeatedly emphasised the importance of emotions and the right hemisphere in his neuropsychological writings. It is surprising, therefore, that Luria's most influential book, The Working Brain, appears to lack an explicit section on these topics. This is especially notable because of a comment in the book's English-language Introduction, by Karl Pribram, referencing Luria's thoughts about precisely this material. Remarkably, it seems that Luria did write such an explicit chapter, in the original Russian edition. However, in the English-language version, the relevant sections were separated, embedded elsewhere without chapter headings, and altered, presumably following an explicit translation decision. The present paper tracks the nature of these changes and, 50 years later, presents the material for the first time translated and reunited in English, as Luria intended. After the translation, we offer a brief commentary, on the ways in which Luria's ideas were in some respects prescient, and in other respects less well-informed about the brain basis of emotions and the right hemisphere. This reunification offers an interesting time capsule on the opinions of one of neuropsychology's greatest minds, on a topic which Luria admits had, at the time, only a modest empirical foundation.

Intraoperative mapping of the right hemisphere: a systematic review of protocols that evaluate cognitive and social cognitive functions.

The right hemisphere of the brain is often referred to as the non-dominant hemisphere. Though this is meant to highlight the specialized role of the left hemisphere in language, the use of this term runs the risk of oversimplifying or minimizing the essential functions of the right hemisphere. There is accumulating evidence from functional MRI, clinical lesion studies, and intraoperative mapping data that implicate the right hemisphere in a diverse array of cognitive functions, including visuospatial functions, attentional processes, and social cognitive functions. Neuropsychological deficits following right hemisphere resections are well-documented, but there is a general paucity of literature focusing on how to best map these functions during awake brain surgery to minimize such deficits. To address this gap in the literature, a systematic review was conducted to examine the cognitive and emotional processes associated with the right hemisphere and the neuropsychological tasks frequently used for mapping the right hemisphere during awake brain tumor surgery. It was found that the most employed tests to assess language and speech functions in patients with lesions in the right cerebral hemisphere were the naming task and the Pyramids and Palm Trees Test (PPTT). Spatial cognition was typically evaluated using the line bisection task, while social cognition was assessed through the Reading the Mind in the Eyes (RME) test. Dual-tasking and the movement of the upper and lower limbs were the most frequently used methods to evaluate motor/sensory functions. Executive functions were typically assessed using the N-back test and Stroop test. To the best of our knowledge, this is the first comprehensive review to help provide guidance on the cognitive functions most at risk and methods to map such functions during right awake brain surgery. Systematic Review Registration: PROSPERO database [CRD42023483324].

A historical approach to models of emotional laterality.

In this paper I discuss the main models that have tried to explain brain asymmetries for emotions. The first models, based on clinical observations, proposed either a general right hemisphere dominance for emotions (the'right hemisphere') model or a different specialization of the right hemisphere for negative and of the left hemisphere for positive emotions (the'valence' model). In more recent times new models, based on partly modified versions of the previous ones have been proposed. The revised version of the 'valence' model, labeled the 'approach-avoidance' model maintained that hemispheric asymmetries are not related to the valence of the emotional stimulus but to the motivational (approach vs avoidance) system that is engaged by that stimulus. On the contrary, revised versions of the 'right hemisphere' hypothesis proposed graded versions of this model, maintaining that only some kinds or some levels of emotions are clearly right lateralized. One version of these models (the'emotion type hypothesis') assumed that only elementary basic emotions should be subsumed by the right hemisphere, wheres more complex social emotions should be subtended by the left hemisphere. The other version (the 'schematic level of emotion hypothesis') assumed that the right hemisphere should subsume only the basic 'schematic' level of emotions, characterized by an automatic and unconscious processing, whereas the more propositional and conscious 'conceptual' level could be less lateralized or subsumed by the left hemisphere. This last model is supported by the obsevation that the right hemisphere reveals a modus operandi (i.e. a prevalence of the 'automatic' over the 'intentional' and of the 'unconscious' over the 'conscious' functional processing) that is typical of the 'schematic level of emotions.

Functional and oncological outcomes after right hemisphere glioma resection in awake versus asleep patients: a systematic review and meta-analysis.

The right hemisphere has been underestimated by being considered as the non-dominant hemisphere. However, it is involved in many functions, including movement, language, cognition, and emotion. Therefore, because lesions on this side are usually not resected under awake mapping, there is a risk of unfavorable neurological outcomes. The goal of this study is to compare the functional and oncological outcomes of awake surgery (AwS) versus surgery under general anesthesia (GA) in supratentorial right-sided gliomas. A systematic review of the literature according to PRISMA guidelines was performed up to March 2023. Four databases were screened. Primary outcome to assess was return to work (RTW). Secondary outcomes included the rate of postoperative neurological deficit, postoperative Karnofsky Performance Status (KPS) score and the extent of resection (EOR). A total of 32 articles were included with 543 patients who underwent right hemisphere tumor resection under awake surgery and 294 under general anesthesia. There were no significant differences between groups regarding age, gender, handedness, perioperative KPS, tumor location or preoperative seizures. Preoperative and long-term postoperative neurological deficits were statistically lower after AwS (p = 0.03 and p < 0.01, respectively), even though no difference was found regarding early postoperative course (p = 0.32). A subsequent analysis regarding type of postoperative impairment was performed. Severe postoperative language deficits were not different (p = 0.74), but there were fewer long-term mild motor and high-order cognitive deficits (p < 0.05) in AwS group. A higher rate of RTW (p < 0.05) was documented after AwS. The EOR was similar in both groups. Glioma resection of the right hemisphere under awake mapping is a safer procedure with a better preservation of high-order cognitive functions and a higher rate of RTW than resection under general anesthesia, despite similar EOR.

Perceiving and misperceiving speech: lexical and sublexical processing in the superior temporal lobes.

Listeners can use prior knowledge to predict the content of noisy speech signals, enhancing perception. However, this process can also elicit misperceptions. For the first time, we employed a prime-probe paradigm and transcranial magnetic stimulation to investigate causal roles for the left and right posterior superior temporal gyri (pSTG) in the perception and misperception of degraded speech. Listeners were presented with spectrotemporally degraded probe sentences preceded by a clear prime. To produce misperceptions, we created partially mismatched pseudo-sentence probes via homophonic nonword transformations (e.g. The little girl was excited to lose her first tooth-Tha fittle girmn wam expited du roos har derst cooth). Compared to a control site (vertex), inhibitory stimulation of the left pSTG selectively disrupted priming of real but not pseudo-sentences. Conversely, inhibitory stimulation of the right pSTG enhanced priming of misperceptions with pseudo-sentences, but did not influence perception of real sentences. These results indicate qualitatively different causal roles for the left and right pSTG in perceiving degraded speech, supporting bilateral models that propose engagement of the right pSTG in sublexical processing.

tDCS of right-hemispheric Wernicke's area homologue affects contextual learning of novel lexicon.

Numerous studies have shown robust evidence of the right hemisphere's involvement in the language function, for instance in the processing of intonation, grammar, word meanings, metaphors, etc. However, its role in lexicon acquisition remains obscure. We applied transcranial direct current stimulation (tDCS) over the right-hemispheric homologue of Wernicke's area to assess its putative involvement in the processing of different types of novel semantics. After receiving 15 min of anodal, cathodal, or sham (placebo) tDCS, three groups of healthy participants learnt novel concrete and abstract words in the context of short stories. Learning outcomes were assessed using a battery of tests immediately after this contextual learning session and 24 h later. As a result, an inhibitory effect of cathodal tDCS and a facilitatory effect of anodal tDCS were found for abstract word acquisition only. We also found a significant drop in task performance on the second day of the assessment for both word types in all the stimulation groups, suggesting no significant influence of tDCS on the post-learning consolidation of new memory traces. The results suggest an involvement of Wernicke's right-hemispheric counterpart in initial encoding (but not consolidation) of abstract semantics, which may be explained either by the right hemispheres direct role in processing lexical semantics or by an indirect impact of tDCS on contralateral (left-hemispheric) cortical areas through cross-callosal connections.

Historical changes in everyday human lifestyles and their effects on hemispheric activation: Speculations on McGilchrist's The Master and His Emissary.

McGilchrist [McGilchrist, I. (2009). The master and His emissary: The divided brain and the making of the modern world. Yale University Press] argued that Western society has undergone a population-level shift from greater right hemisphere influence on cognition to increasingly greater left hemisphere influence over the past few centuries. Four historical lifestyle changes that replaced behaviours associated with right hemisphere activation with behaviours associated with left hemisphere activation may be responsible: (i) shifts from standing to sitting, (ii) from being outdoors to indoors, (iii) from communal to solitary activities, and (iv) from analogue/concrete to holistic/abstract representations.

Mainly Visual Aspects of Emotional Laterality in Cognitively Developed and Highly Social Mammals-A Systematic Review.

Several studies have shown that emotions are asymmetrically represented in the human brain and have proposed three main models (the 'right hemisphere hypothesis', the 'approach-withdrawal hypothesis' and the 'valence hypothesis') that give different accounts of this emotional laterality. Furthermore, in recent years, many investigations have suggested that a similar emotional laterality may also exist in different animal taxa. However, results of a previous systematic review of emotional laterality in non-human primates have shown that some of these studies might be criticized from the methodological point of view and support only in part the hypothesis of a continuum in emotional laterality across vertebrates. The aim of the present review therefore consisted in trying to expand this survey to other cognitively developed and highly social mammals, focusing attention on mainly visual aspects of emotional laterality, in studies conducted on the animal categories of horses, elephants, dolphins and whales. The 35 studies included in the review took into account three aspects of mainly visual emotional laterality, namely: (a) visual asymmetries for positive/familiar vs. negative/novel stimuli; (b) lateral position preference in mother-offspring or other affiliative interactions; (c) lateral position preference in antagonistic interactions. In agreement with data obtained from human studies that have evaluated comprehension or expression of emotions at the facial or vocal level, these results suggest that a general but graded right-hemisphere prevalence in the processing of emotions can be found at the visual level in cognitively developed non-primate social mammals. Some methodological problems and some implications of these results for human psychopathology are briefly discussed.

Comparing two versions of the Chimeric Face Test: A pilot investigation.

The Chimeric Face Test (CFT) is a widely used behavioral measure of degree of lateralization for emotion processing. The Pictures of Facial Affect (Ekman, 1976 [Pictures of facial affect. Consulting Psychologists Press.]) have often been used to create chimeras for this task but have widely been critiqued due to lack of ethnic diversity and small stimuli numbers. In this brief study participants (N = 45) completed two Chimeric Face Tests, one using the Pictures of Facial Affect and one using the NimStim facial stimuli (Tottenham et al., 2009 [The NimStim set of facial expressions: Judgments from untrained research participants. Psychiatry Research, 168(3), 242-249]). The laterality scores were compared across measures. The results show the two measures are related; laterality quotients showed a strong correlation between the two tasks. Participants showed a left-visual field bias on both tasks, indicative of a right-hemisphere bias for the processing of emotions. The NimStim Chimeric Face Test however was found to give a more conservative estimate of degree of lateralization. The NimStim Chimeric Face Test is discussed as a valid measure for examining lateralization for emotion processing, The extent to which different versions of the Chimeric Face Test are comparable is discussed.

Evaluation of driving fitness using driving simulators in patients with right-hemisphere damage: an unmatched case-control study.

BACKGROUND: Patients with right hemisphere damage (RHD) may exhibit mild unilateral spatial neglect (USN), which is difficult to detect in general assessments performed during driving rehabilitation. OBJECTIVES: We compared driving simulator performance, practical driving performance, and neuropsychological test results between patients with RHD who were able and unable to return to driving to predict driving fitness based on driving simulator performance. METHODS: This unmatched case-control study included 29 patients with RHD who were able (return-to-driving group, n = 16) and unable (non-return-to-driving group, n = 13) to return to driving. Patient demographics, motor function, attention, driving simulator performance (participants' reaction time and rate to green lamps appearing in any of the three displays and average lane position), and practical driving performance were compared between the groups. Receiver operating characteristic (ROC) analysis was performed to examine the predictive performance of driving fitness in reaction rate and paper-and-pencil tests. RESULTS: The non-return-to-driving group had a significantly lower reaction rate than the return-to-driving group (p = 0.027; 95% confidence interval [CI], 0-7; r = 0.407). No significant difference in reaction time or lane position in either the left or right lane during driving simulation was observed. ROC analysis of the reaction rate in the driving simulator task showed sensitivity of 0.692, specificity of 0.812, and area under the curve of 0.738 [95% CI, 0.541-0.935]. CONCLUSIONS: Decreases in reaction rates during simulated driving assessments are associated with an inability to resume driving in patients with RHD. Such assessments may aid in predicting fitness for driving in these patients.

Is Anosognosia for Left-Sided Hemiplegia Due to a Specific Self-Awareness Defect or to a Poorly Conscious Working Mode Typical of the Right Hemisphere?

This review aimed to evaluate whether the association between 'anosognosia for hemiplegia' and lesions of the right hemisphere points to a special self-awareness role of the right side of the brain, or could instead be due to a working mode typical of the right hemisphere. This latter viewpoint is consistent with a recently proposed model of human brain asymmetries that assumes that language lateralization in the left hemisphere might have increased the left hemisphere's level of consciousness and intentionality in comparison with the right hemisphere's less conscious and more automatic functioning. To assess these alternatives, I tried to ascertain whether anosognosia is greater for left-sided hemiplegia than for other disorders provoked by right brain lesions, or whether unawareness prevails in tasks more clearly related to the disruption of the right hemisphere's more automatic (and less conscious) functioning. Data consistent with the first alternative would support the existence of a specific link between anosognosia for hemiplegia and self-awareness, whereas data supporting the second option would confirm the model linking anosognosia to a poorly conscious working mode typical of the right hemisphere. Analysis results showed that the incidence of anosognosia of the highly automatic syndrome of unilateral neglect was greater than that concerning the unawareness of left hemiplegia, suggesting that anosognosia for left-sided hemiplegia might be due to the poorly conscious working mode typical of the right hemisphere.

Resting state correlates of picture description informativeness in left vs. right hemisphere chronic stroke.

Introduction: Despite a growing emphasis on discourse processing in clinical neuroscience, relatively little is known about the neurobiology of discourse production impairments. Individuals with a history of left or right hemisphere stroke can exhibit difficulty with communicating meaningful discourse content, which implies both cerebral hemispheres play a role in this skill. However, the extent to which successful production of discourse content relies on network connections within domain-specific vs. domain-general networks in either hemisphere is unknown. Methods: In this study, 45 individuals with a history of either left or right hemisphere stroke completed resting state fMRI and the Cookie Theft picture description task. Results: Participants did not differ in the total number of content units or the percentage of interpretative content units they produced. Stroke survivors with left hemisphere damage produced significantly fewer content units per second than individuals with right hemisphere stroke. Intrinsic connectivity of the left language network was significantly weaker in the left compared to the right hemisphere stroke group for specific connections. Greater efficiency of communication of picture scene content was associated with stronger left but weaker right frontotemporal connectivity of the language network in patients with a history of left hemisphere (but not right hemisphere) stroke. No significant relationships were found between picture description measures and connectivity of the dorsal attention, default mode, or salience networks or with connections between language and other network regions. Discussion: These findings add to prior behavioral studies of picture description skills in stroke survivors and provide insight into the role of the language network vs. other intrinsic networks during discourse production.

Exploring Pragmatic Deficits in Relation to Theory of Mind and Executive Functions: Evidence from Individuals with Right Hemisphere Stroke.

Research investigating pragmatic deficits in individuals with right hemisphere damage focuses on identifying the potential mechanisms responsible for the nature of these impairments. Nonetheless, the presumed shared cognitive mechanisms that could account for these deficits have not yet been established through data-based evidence from lesion studies. This study aimed to examine the co-occurrence of pragmatic language deficits, Theory of Mind impairments, and executive functions while also exploring their associations with brain lesion sites. Twenty-five patients suffering from unilateral right hemisphere stroke and thirty-seven healthy participants were recruited for this study. The two groups were tested in pragmatics, Theory of Mind, and executive function tasks. Structural imaging data were also obtained for the identification of the lesion sites. The findings of this study suggest a potential convergence among the three aforementioned cognitive mechanisms. Moreover, we postulate a hypothesis for a neural circuitry for communication impairments observed in individuals with right hemisphere damage.

Neuropragmatics: A scientometric review.

Neuropragmatics investigates brain functions and neural activities responsible for pragmatic language abilities, often impaired in disorders such as hemisphere damage, autism, schizophrenia, and neurodegenerative disorders. This study examined the development of neuropragmatics and existing neuroimaging evidence using bibliometric and scientometric indicators, analyzing 4,247 documents published between 1967 and 2022 with CiteSpace and VOSviewer. Our cluster analysis revealed key themes. 1) Language comprehension loss due to brain injury: Studies exploring the impact of brain injuries on language comprehension and underlying neural mechanisms. 2) Right hemisphere damage and pragmatic language skills: Research focusing on the relationship between right hemisphere damage and pragmatic language abilities, investigating impairments in social language use and potential neural correlates. 3) Traumatic brain injury and social communication assessment: Research on traumatic brain injury effects on social communication skills, using various assessment tools to evaluate communication effectiveness in social situations. These clusters provide valuable insights into the neuropragmatics field and serve as a framework for future investigations. By building upon existing knowledge, researchers can improve our understanding of brain functions, language behavior, and enhance rehabilitation for individuals with pragmatic language impairments.

The right hemisphere's capacity for language: evidence from primary progressive aphasia.

The role of the right hemisphere (RH) in core language processes is still a matter of intense debate. Most of the relevant evidence has come from studies of gray matter, with relatively little research on RH white matter (WM) connectivity. Using Diffusion Tensor Imaging-based tractography, the current work examined the role of the two hemispheres in language processing in 33 individuals with Primary Progressive Aphasia (PPA), aiming to better characterize the contribution of the RH to language processing in the context of left hemisphere (LH) damage. The findings confirm the impact of PPA on the integrity of the WM language tracts in the LH. Additionally, an examination of the relationship between tract integrity and language behaviors provides robust evidence of the involvement of the WM language tracts of both hemispheres in language processing in PPA. Importantly, this study provides novel evidence of a unique contribution of the RH to language processing (i.e. a contribution independent from that of the language-dominant LH). Finally, we provide evidence that the RH contribution is specific to language processing rather than being domain general. These findings allow us to better characterize the role of RH in language processing, particularly in the context of LH damage.

Eating-induced seizures: A semiological sign of the right temporal pole.

OBJECTIVE: Eating-induced seizures (EIS) are a rare form of reflex seizures. The objective of this study was to report a series of cases of EIS involving patients admitted to our epilepsy unit, and to analyze the clinical characteristics, etiology, and treatment response of this type of infrequent seizure. METHODS: We performed a single-center retrospective analysis of all consecutive patients diagnosed with epilepsy with eating-induced seizures between 2008 and 2020. RESULTS: We included eight patients (six women) with mean age 54.75 years (range: 40-79), and mean age at epilepsy onset 30.75 years (range: 9-58 years). EIS were triggered during a meal in 5/8 (at dinner 1/8, at breakfast in 1/8, and without time preference in 3/8), by a certain flavor in 1/8, by eating different textures or drinking soft drinks in 1/8, and by slicing food in 1/8. All patients suffered nonreflex seizures and 3/8 other types of reflex seizures. In 6/8 of patients, EIS originated in the right hemisphere. In 5/8, the EIS progressed to impaired awareness with oromandibular automatisms. In 6/8, the epilepsy was drug-resistant. Temporopolar encephalocele was the most frequent etiology, in 4/8. Three of the eight underwent surgical treatment, with Engel IA 1 year in 3/3. Three of the eight were treated with vagal stimulation therapy, with McHugh A 1 year in 2/3. SIGNIFICANCE: In our series, eating-induced seizures were observed in patients with focal epilepsy. It was frequently drug-resistant and started predominantly in the right hemisphere, due to temporal pole involvement in half of the patients.

Major complications associated with unfavorable outcome in right-sided large hemisphere infarctions: A single-center study.

OBJECTIVES: To identify the major complications independently associated with unfavorable outcomes in right-sided large hemisphere infarction (RLHI) patients. METHODS: We retrospectively enrolled consecutive patients admitted within 24 h with the diagnosis of RLHI. The unfavorable outcome was defined as a modified Rankin Scale score of 4-6 at 3 months. Univariate and multivariate analyses were performed to identify the major complications independently associated with 3-month unfavorable outcomes. RESULTS: Of the 171 cases with RLHI included, 126 (73.7%) had unfavorable outcomes at 3 months: A total of 64 (37.4%) cases died, and 62 (36.3%) lived with severe disability. Stroke-related complications occurred in 168 (98.2%) patients during hospitalization. The five most common stroke-related complications were pulmonary infection (75.4%), electrolyte disorder (61.4%), hypoalbuminemia (49.1%), malignant brain edema (MBE) (48.5%), and hemorrhagic transformation (48.0%). RLHI patients with unfavorable outcomes had more frequent MBE (58.7% vs. 21.4%, p < .001), pulmonary infection (86.5% vs. 42.9%, p < .001), gastrointestinal bleeding (46.8% vs. 28.6%, p = .038), electrolyte disorder (68.3% vs. 40.5%, p = .001), acute renal failure (32.5% vs. 4.8%, p < .001), and hypoalbuminemia (61.1% vs. 11.9%, p < .001) than patients with favorable outcome. Multivariate analyses suggested that only MBE (adjusted OR 4.06, 95% confidence interval [CI] 1.14-14.48, p = .031), pulmonary infection (adjusted OR 4.69, 95%CI 1.48-14.85, p = .009), and hypoalbuminemia (adjusted OR 6.58, 95%CI 1.74-24.86, p = .005) were independently associated with 3-month unfavorable outcome in patients with RLHI. CONCLUSIONS: Most of the RLHI patients have at least one stroke-related complication during hospitalization, and nearly three-quarters suffered unfavorable outcomes. Only MBE, pulmonary infection, and hypoalbuminemia are independently associated with 3-month unfavorable outcome.