Structural asymmetries in normal brain anatomy: A brief overview

A fundamental feature in interpreting gross or neuroimaging brain anatomy is reliance on an assumed high degree of morphologic symmetry in bilateral hemispheres. However, the normal brain is not perfectly symmetrical, and subtle inherent structural asymmetries could potentially confound appreciation of pathology-induced asymmetry or how a given brain asymmetry can relate to its function.We review the literature and provide a brief overview of structural asymmetries in normal brain anatomy.Brain structural asymmetries are either rotational or pure right-left asymmetries, and many are a consequence of unique features linked to the use of human language. Yakovlevian torque is the tendency of the right hemisphere to rotate slightly forward relative to the left, which may make the right frontal lobe bigger and wider, and the left occipital lobe wider and protrude rightward. This makes the left Sylvian fissure longer and flatter, resulting in a larger planum temporale. We also discuss right-left asymmetries in the cortex, white matter structures, deep gray nuclei, and lateral ventricles. Brain asymmetries are not random but result from distinct patterns in structural design that confer evolutionary functional advantages.Minor brain asymmetries are important and should be accounted for as they can be connected to function, and like individual variability, are essential for evolution. This overview will help understand structural brain asymmetries for improved diagnostic neuroimaging interpretation, constructing symmetry-based paradigms for automatic localization, segmentation of brain lesions, and as a reference for studies on possible implications of excessive asymmetry and altered laterality in cognitive, neurological, and psychiatric disorders.