The relationship between brain and visceral asymmetry: Evidence from situs inversus in humans

This review examines the relationship between visceral and brain asymmetry and explores whether their alignment observed in some vertebrate species also exists in humans. While the development of visceral and brain asymmetry may have occurred for different reasons, it is possible that the basic mechanisms for left-right differentiation of the visceral system were duplicated in the brain. We describe the main phenotypical anomalies and the general mechanism of left-right differentiation in vertebrates, followed by a systematic review of available human studies on behavioral and brain asymmetry in individuals with reversed visceral organization. The available evidence shows no direct link between human visceral and brain laterality. Most individuals with situs inversus totalis (SIT) show typical population biases for handedness and brain functional asymmetry, although an increased prevalence of atypical hemispheric segregation may be present. Perisylvian brain structural asymmetries also reveal the expected population bias in participants with SIT. However, several independent studies indicate that SIT is associated with a general reversal of the gross morphologic asymmetry of brain torque. Potential differences in brain structural and functional asymmetries between subtypes of situs inversus with ciliary and nonciliary causes remain to be determined.