Crossed buccofacial apraxia.

The cerebral hemisphere contralateral to the preferred hand is generally dominant for learned representational motor acts, including those involving buccofacial muscles. It is generally also language-dominant. This buccofacial apraxia has, with rare exceptions, been associated with left hemispheric lesions in right-handers. We describe two patients with severe buccofacial apraxia caused by large middle cerebral artery territory infarcts in the hemisphere ipsilateral to the preferred hand and nondominant for language. Neither patient had aphasia or major limb apraxia. Computed tomographic scans in the first patient and neuropathologic examination in the second failed to reveal an abnormality of the hemisphere contralateral to the preferred hand. Hence, in some individuals, the hemisphere controlling skilled representational buccofacial movements may not be the one that is dominant either for handedness or for language.