Right sided weakness with right subdural hematoma: motor deafferentation of left hemisphere resulted in paralysis of the right side.

BACKGROUND

A right handed man with trauma to the head was admitted with headache and seizures. A severe right sided weakness was noted after a blunt trauma to the right side of his head.

METHODS AND RESULTS

MRI of brain revealed a right-sided subdural hematoma and a normal left hemisphere and downstream motor pathways. Bimanual simultaneous drawing and manual reaction times indicated that the patient was right hemispheric in laterality of his major hemisphere.

CONCLUSION

The right sided weakness in this patient was due to temporary transcallosal disconnection (diaschisis) of the minor hemisphere (left, in this case) from the excitatory signals arising from those structures of his major hemisphere devoted to movements occurring on nondominant side, transmitted via the corpus callosum to his left hemisphere. This case draws attention to disparity between neural and behavioral handedness (laterality of major hemisphere versus that of the preferred hand). Drawing longer lines by the left hand in simultaneous bimanual tasks and a slower simple reaction time to central visual stimuli by the ostensible dominant hand permitted lateralization of the major hemisphere to the right. Thus, the neurally nondominant side (right) lagged behind the dominant (left) by an interval equal to interhemispheric transfer time.