“Right Brain Has Nothing Left; Left Brain Has Nothing Right”: An Interesting Complication of Posttraumatic Corpus Callosal Bleed Presenting with Split-Brain Syndrome — A Case Report and Review of Literature

Abstract

Gross and microscopic lesions of corpus callosum and neighboring structures are common in severe closed head injury. Left limb apraxia after damage to corpus callosum has been reported in patients whose neocortical commissures were sectioned for relief of severe epilepsy and in patients affected by naturally occurring lesions either of vascular or neoplastic origin. Only few reports are found in literature to have split-brain syndrome or disconnection syndrome of traumatic origin. Here we present a patient with left-sided apraxia, agraphia, and tactile anomia with right-sided constructional disturbances after a severe head injury with corpus callosal bleed.

Left-sided apraxia was profound on verbal command, visual presentation of an object, and imitation, but not during tactile presentation or the actual use of the objects. These data are consistent with left hemisphere dominance for praxis, which is almost absolute when the retrieval of the appropriate gesture requires a semantic analysis of the stimulus.

Keywords

severe closed head injury - corpus callosum - split-brain syndrome - left-sided apraxia - neuropsychological tests

• Reference

• 1 Rubens AB, Geschwind N, Mahowald MW, Mastri A. Posttraumatic cerebral hemispheric disconnection syndrome. Arch Neurol 1977; 34 (12) 750-755
• 2 Lindenberg R, Fisher RS, Durlacher SH, Lovitt Jr WV, Freytag E. Lesions of the corpus callosum following blunt mechanical trauma to the head. Am J Pathol 1955; 31 (2) 297-317
• 3 Damasio AR, Chui HC, Corbett J, Kassel N. Posterior callosal section in a non-epileptic patient. J Neurol Neurosurg Psychiatry 1980; 43 (4) 351-356
• 4 Sperry RW, Gazzaniga MS, Bogen JE. Interhemispheric relationships: the neocortical commissures; syndromes of hemisphere disconnection. Handb Clin Neurol 1969; 4: 273-290
• 5 Gazzaniga MS, Sperry RW. Language after section of the cerebral commissures. Brain 1967; 90 (1) 131-148
• 6 Watson RT, Heilman KM. Callosal apraxia. Brain 1983; 106 (Pt 2): 391-403
• 7 Sperry RW. Mental unity following surgical disconnection of the cerebral hemispheres. Harvey Lect 1966– 1967; 62: 293-323
• 8 Zaidel D, Sperry RW. Some long-term motor effects of cerebral commissurotomy in man. Neuropsychologia 1977; 15 (2) 193-204
• 9 Risse GL, LeDoux J, Springer SP, Wilson DH, Gazzaniga MS. The anterior commissure in man: functional variation in a multisensory system. Neuropsychologia 1978; 16 (1) 23-31
• 10 Degos JD, Gray F, Louarn F, Ansquer JC, Poirier J, Barbizet J. Posterior callosal infarction. Clinicopathological correlations. Brain 1987; 110 (Pt 5): 1155-1171
• 11 Geschwind N. Disconnexion syndromes in animals and man. II. Brain 1965; 88 (3) 585-644
• 12 Gazzaniga MS, Freedman H. Observations on visual processes after posterior callosal section. Neurology 1973; 23 (10) 1126-1130
• 13 Boldrini P, Zanella R, Cantagallo A, Basaglia N. Partial hemispheric disconnection syndrome of traumatic origin. Cortex 1992; 28 (1) 135-143
• 14 Benavidez DA, Fletcher JM, Hannay HJ , et al. Corpus callosum damage and interhemispheric transfer of information following closed head injury in children. Cortex 1999; 35 (3) 315-336
• 15 Jang SH, Lee J, Yeo SS, Chang MC. Callosal disconnection syndrome after corpus callosum infarct: a diffusion tensor tractography study. J Stroke Cerebrovasc Dis 2013; 22 (7) e240-e244
• 16 De Renzi E, Motti F, Nichelli P. Imitating gestures. A quantitative approach to ideomotor apraxia. Arch Neurol 1980; 37 (1) 6-10