Liepmann's Imperial Counselor Re-visited: The First Documented Case of Disparity of Neural and Behavioral Handedness

After more than a century, Hugo Liepmann continues to hold a special position in elucidating the anatomy that underpins laterality of motor control (handedness). In this note, I will provide data as to the reason behind the right-sidedness of the apraxia in this patient, elucidating the exceptional laterality of his symptom (apraxia). Introduced to us as The Imperial Counselor, 1 the patient had been right handed all his life. Liepmann's observations and the interpretations he advanced to explain them, linked the two hemispheres in the following manner: 1. As shown in the drawings of the year 1900 (Figs.1, 2), Liepmann recognized for the first time that motor signals between the two hemispheres had directionality (from the left to the right). 2. He also recognized that the major hemisphere plays a special role in the planning and execution of motor commands on both sides of the body. He was puzzled, however, by the " exceptional " right sidedness of apraxia in this patient; the only exception among remainder of his cases, where the apraxia had affected the left hand (in 21 out of the 40 cases with left hemispheric lesions). 2 3. Liepmann knew that directionality of callosal traffic he was espousing was related to handedness of his subjects and believed that the Counselor's exceptional laterality of symptom (apraxia) might be due to the subject's (latent) left handedness, as the Counselor had dealt cards with his left hand. It remains a puzzle as to why Liepmann did not take the logical step of distinguishing neural from behavioral handedness in his patient since he knew the anatomical distinction between the dominant and nondominant side of the body as they related to the laterality of command center, as seen in his drawings (Figs. 1, 2). Further, Liepmann realized that Counselor's drawings were perfect when drawn by the left hand, while those drawn by the right were mere squiggles. The photographs taken of the Counselor's use of a brush held with the right hand (rubbing his ear), and that of drinking water from a glass held with the same (Figs 3, 4) demonstrated the right sidedness of the apraxia; as did his abnormal performance in moving the right foot. The same movements by the left hand were performed correctly. Addressing the laterality of apraxia in usual circumstances Liepmann remarked: " Part of what left hand " can do " is not is not a …