FMRI findings in an aphasic patient with reversed cerebral dominance for language

An 80-year-old right-handed woman with no history of brain damage or familial strain of left-handedness acutely developed aphasia associated with a left hemiparesis following a right hemisphere stroke. Brain MRI showed a posterior insular ischemic infarction extending to the temporo-parietal region of the right hemisphere. Severe overall language disruption (global aphasia) in the acute phase of the stroke rapidly evolved into conduction aphasia, characterized by a neurolinguistic profile of disproportionately severe repetition deficits and markedly distorted phonological skills. In the lesion phase of the stroke, a functional MRI study using a word repetition task was conducted which revealed a consistent pattern of right hemisphere activations. For the first time, right hemisphere language dominance is demonstrated by fMRI in a clear instance of crossed aphasia in a dextral.