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When a Large Left Hemisphere Stroke is All Right for Language, Praxis, and Visual Attention: A Case Report
Elizabeth H T Chang1, Peter E Turkeltaub1,2, Anna Seydell-Greenwald1
1Center for Brain Plasticity and Recovery, Georgetown University Medical Center.
Neurology Open Access
|January 23, 2026
Summary
A rare case of stroke in the dominant left hemisphere (LH) showed preserved language and cognitive functions, indicating atypical right hemisphere (RH) dominance. This finding challenges traditional views on brain lateralization.
Area of Science:
- Neuroscience
- Cognitive Neurology
- Neuroimaging
Background:
- Large strokes typically cause significant functional deficits based on hemisphere dominance.
- Atypical lateralization of cognitive functions is a known phenomenon but rarely documented in such extensive damage.
Purpose of the Study:
- To report a unique case of a large left hemisphere (LH) stroke with preserved language, praxis, and visuospatial cognition.
- To investigate the potential for simultaneous functional lateralization to the intact right hemisphere (RH).
Main Methods:
- A 53-year-old woman with a history of LH MCA stroke underwent comprehensive behavioral assessments.
- Functional magnetic resonance imaging (fMRI) was utilized to assess brain activity during cognitive tasks.
Main Results:
- Despite extensive LH damage, the patient maintained intact language (W-AB AQ=99.2) and praxis.
- fMRI revealed right-hemisphere dominance for language, with preserved visuospatial cognition and attention despite right hemianopia.
Conclusions:
- This case demonstrates that language, praxis, and visuospatial functions can independently lateralize to the RH.
- The phenomenon of "crossed non-aphasia" supports flexible and independent functional lateralization, relevant for understanding post-stroke deficits.
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