Praxis and writing in a right-hander with crossed aphasia.

Studies of patients with brain lesions have demonstrated that language and praxis are mediated by dissociable networks. However, language has the capacity to influence the selection of purposeful actions. The abilities to use language and to program purposeful movements are often mediated by networks that have anatomic proximity. With hemispheric injury, the diagnosis of apraxia is often confounded by the specific influence of language impairments on the ability to select and produce transitive gestures. We report a patient who illustrates this confound. This patient is a right-handed man who developed global aphasia and neglect after a right hemispheric stroke. His right hand remained deft, and when asked to produce specific transitive gestures (pantomimes), he often performed normally but did make some body part as object and perseverative errors. However, he did not demonstrate the temporal or spatial errors typical of ideomotor apraxia. He also had a perseverative agraphia. Our patient's left hemisphere praxis system appeared to be intact, and the error types demonstrated during production of transitive gestures cannot be attributed to a degradation of postural and movement (praxis) programs mediated by his left hemisphere. The praxis errors types are most consistent with a deficit in the ability to select the necessary praxis programs. Thus, our patient appeared to have dissociation between language and praxis programs that resulted in body part as object and perseverative errors.

The effects of left and right monocular viewing on hemispheric activation.

BACKGROUND/OBJECTIVES: Prior research has revealed that whereas activation of the left hemisphere primarily increases the activity of the parasympathetic division of the autonomic nervous system, right-hemisphere activation increases the activity of the sympathetic division. In addition, each hemisphere primarily receives retinocollicular projections from the contralateral eye. A prior study reported that pupillary dilation was greater with left- than with right-eye monocular viewing. The goal of this study was to test the alternative hypotheses that this asymmetric pupil dilation with left-eye viewing was induced by activation of the right-hemispheric-mediated sympathetic activity, versus a reduction of left-hemisphere-mediated parasympathetic activity. Thus, this study was designed to learn whether there are changes in hemispheric activation, as measured by alteration of spontaneous alpha activity, during right versus left monocular viewing. METHOD: High-density electroencephalography (EEG) was recorded from healthy participants viewing a crosshair with their right, left, or both eyes. RESULTS: There was a significantly less alpha power over the right hemisphere's parietal-occipital area with left and binocular viewing than with right-eye monocular viewing. CONCLUSIONS: The greater relative reduction of right-hemisphere alpha activity during left than during right monocular viewing provides further evidence that left-eye viewing induces greater increase in right-hemisphere activation than does right-eye viewing.

Right hemispatial ipsilesional neglect with chronic right hemisphere strokes.

BACKGROUND: Patients who present with spatial neglect after stroke often perform normally on tests for neglect after a few weeks. Whereas tests for neglect are often performed directly in front of a patient, in their actual environments many important stimuli may be present within their left or right hemispace. The presence and severity of neglect often depends on the hemisphere injured. It is possible, in chronic stroke, for spatial judgments to be influenced by an interaction of stroke laterality and the spatial location of stimuli. The objective of this study was to learn if unilateral hemispheric chronic strokes contribute to a spatial bias with laterally presented stimuli. METHOD: There were 70 participants, 62 with unilateral chronic strokes (>6 months post onset) including 35 with left hemisphere damage (LHD), 27 with right hemisphere damage (RHD), and 8 demographically similar people without history of stroke. Participants were asked to bisect 300 lines presented with distractors on the left, right, or both sides of the line, or no distractor, on a touch-screen monitor in right, center or left hemispace. RESULTS: There was a significant interaction between the side of the hemispheric lesion and the side of the body where these lines were presented. Specifically, in right space, patients with RHD deviated leftward in comparison to the other groups. Furthermore, there was an interaction between group and distractor induced bias. All three groups approached the left distractor, and the patients with LHD also approached the right distractor. CONCLUSIONS: Although spatial neglect is more severe in contralesional than ipsilesional hemispace in the period immediately following a stroke, over time patients with RHD may develop ipsilesional neglect that is more severe in ipsilesional than contralesional space. The mechanism underlying this bias is not known and may be related to attempted compensation or the development of a contralateral attentional/intentional grasp.

The effects of constrained left versus right monocular viewing on the autonomic nervous system.

Asymmetrical activation of right and left hemispheres differentially influences the autonomic nervous system. Additionally, each hemisphere primarily receives retinocollicular projections from the contralateral eye. To learn if asymmetrical hemispheric activation induced by monocular viewing would influence relative pupillary size and respiratory hippus variability (RHV), a measure of parasympathetic activity, healthy participants had their left, right or neither eye patched. Pupillary sizes were then recorded with infrared pupillography. Pupillary dilation was significantly greater with left than right eye viewing. RHV, however, was not different between eye viewing conditions. These differences in pupil dilatation may have been caused by relatively greater activation of the right hemispheric-mediated sympathetic activity induced by left monocular viewing or relatively greater deactivation of the left hemispheric-mediated parasympathetic activity induced by right eye patching. The absence of an asymmetry in RHV, however, suggests that hemispheric asymmetry of sympathetic activation was primarily responsible for this ocular asymmetry of pupil dilation.

Impaired initial vowel versus consonant letter-word fluency in dementia of the Alzheimer type.

OBJECTIVES: Early detection of Alzheimer disease (AD) is important. With AD, the loss of connectivity should first induce dysfunction in those representational networks with the weakest connectivity. Less frequently used networks have weaker connectivity. Given the letter "A" has more phonemes than the letters "F" and "S", fewer words would begin with each of these "A" phonemes than with the "F" or "S" phonemes. We wanted to learn if patients with AD would produce fewer words starting with "A". METHODS: Patients with AD, mild cognitive impairment (MCI), and normal participants, were assessed with the Controlled Oral Word Association (COWA) test. RESULTS: Compared to controls and MCI patients, AD patients produced relatively fewer words beginning with "A" than with "F" and "S". CONCLUSIONS: These results support the postulate that the less frequently used, and thus more weakly connected, phonetic-lexical networks are more sensitive to the degradation induced by AD.

The blindside: impact of monocular occlusion on spatial attention.

Monocular occlusion has been posited to reduce activation of the contralateral hemisphere ("Sprague effect"), thus inducing a contralateral spatial bias (toward the viewing eye). Healthy right-handed participants bisected horizontal lines during monocular eye viewing. Although subjects tended to deviate away from the viewing eye, only left-eye viewing deviated significantly right of midline. These results suggest that eye patching may induce an attentional compensation similar to that in hemianopic patients. Alternatively, increased activation of higher cortical regions mediating spatial attention in contralateral hemispace may be an adaptive response to decreased activation of its ipsilateral superior colliculus induced by contralateral eye patching.