On the problems of speech compensation and fluctuating intellectual performance.

Some of the factors involved in compensation of speech deficits following local brain lesions are enumerated. An illustrative case is presented of a right-handed patient who failed to become aphasic despite massive resections for glioma from the left hemisphere. The surprising degree of speech intactness is discussed according to theories of interhemispheric transfer of speech function and the possibility that the right hemisphere had originally been the dominant hemisphere for speech, a so-called "ectopic speech center." It has been known for many years that an aphasic patient with a left hemisphere lesion has a better prognosis if a family history of left handedness is present. A sister of the patient reported here, although right-handed, is shown by dichotic listening studies to be right hemisphere dominant for speech. Thus, it is suggested that this finding on dichotic listening tests in a close relative may prove to be a favorable prognostic sign for compensation of the speech function. The patient also showed fluctuating intellectual performance and a curious "warming up" phase for the individual neuropsychological tasks. Data is presented from simultaneous neuropsychological testing and an integrated EEG frequency analysis which demonstrates an electrophysiological and behavioral correlation. The question arises as to whether the fluctuations frequently seen in brain-damaged patients might have a similar electrophysiological association.