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A line of disagreement, as old as neurology itself, pertains to the relationship between the two cerebral hemispheres Fechner, in 1860, speculated that since the two hemispheres, joined by the corpus callosum, were virtual mirror images of one another and functioned in totality in conscious life, separating them would result in two minds William McDougall rejected this idea and is said to have offered to have his own brain divided by Charles Sherrington should he have an incurable disease He died of cancer, but the callosotomy was considered unnecessary, for already there were indications from the work of Sperry and colleagues that when separated, the two hemispheres had different functions, as indicated in the next section, Disconnection Syndromes The practice of surgical sectioning of the corpus callosum for the control of epilepsy had greatly stimulated interest in the functions of the right cerebral hemisphere when isolated from the left It is in the sphere of visuospatial perception that right hemispheral dominance is most convincing Lesions of the right posterior cerebral region result in an inability to utilize information about spatial relationships in making perceptual judgments and in responding to objects in a spatial framework This is manifest in constructing gures (constructional apraxia), in the spatial orientation of the patient in relation to the environment (topographic agnosia), in identifying faces (prosopagnosia), and in relating a scattering of visual stimuli to one another (simultanagnosia) Also, there are claims that the right hemisphere is more important than the left in visual imagery, attention, emotion (both in feeling and in the perception of emotion in others), and manual drawing (but not writing); in respect to these functions, however, the evidence

is less rm The idea that attention is a function of the right hemisphere derives from the neglect of left visual space and of somatic sensation in the anosognosic syndrome and also from the apathy that characterizes such patients Certainly the popular notion of the right hemisphere as emotional in contrast to the left one as logical has no basis in fact and represents a gross oversimpli cation of brain function and localization Similar issues arise, of course, in relation to handedness and language dominance in the left hemisphere as discussed in the following chapter Here we only comment on how intriguing it is that praxis and linguistic skill are aligned on the same side of the brain, suggesting that an essential property of the dominant hemisphere is its ability to comprehend and manipulate symbolic representations of all types

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Following the insightful clinical observations and anatomic studies of Wernicke, Dejerine, and Liepmann, the concept of disconnection of parts of one or both cerebral hemispheres as a cause of neurologic dif culty was introduced to neurologic thinking In more recent years, these ideas were resurrected and modernized by Geschwind and greatly extended by Sperry and by Gazzaniga Geschwind called attention to several clinical syndromes resulting from interruption of the connections between the two cerebral hemispheres in the corpus callosum or between different parts of one hemisphere Some of these are illustrated in Fig 22-6 When the entire corpus callosum is destroyed by tumor or surgical section, the language and perception areas of the left hemisphere are isolated from the right hemisphere Patients with such lesions, if blindfolded, are unable to match an object held in one hand with that in the other Objects placed in the right hand are named correctly, but not those in the left Furthermore, if rapid presentation is used to avoid bilateral visual scanning, such patients cannot match an object seen in the right half of the visual eld with one in the left half They are also alexic in the left visual eld, since the verbal symbols that are seen there and are projected to regions of the right hemisphere have no access to the language areas of the left hemisphere If given a verbal command, such patients will execute it correctly with the right hand but not with the left; if asked to write from dictation with the left hand, they will produce only an illegible scrawl Many remarkable conclusions regarding the nature of behavior and the special roles of each cerebral hemisphere have been drawn from clever observations of patients with callosal section Extensive discussion of these neuropsychologic abnormalities cannot be undertaken here; suf ce it to say that these are not features seen in patients with the usual neurologic diseases, but they are nonetheless of interest to neurologists and are discussed in the writings of Gazzaniga In most lesions con ned to the posterior portion of the corpus callosum (splenium), only the visual part of the disconnection syndrome occurs Cases of occlusion of the left posterior cerebral artery provide the best examples Since infarction of the left occipital lobe causes a right homonymous hemianopia, all visual information needed for activating the speech areas of the left hemisphere must thereafter come from the right occipital lobe The patient with a lesion of the splenium of the corpus callosum or the adjacent white matter cannot read or name colors because the visual information cannot reach the left language areas There is, however, no dif culty in copying words; presumably the visual information for ac-.

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