Female, 81 years old, with history of atypical meningioma status post resection, with recent progressive left leg dysfunction causing gait disorder. Assess for cause of left leg dysfunction. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Specifically, cortical activation related to foot movement is seen bilaterally at the high paramedian vertex of the precentral gyri. The degree of cortical activation is, if anything, somewhat greater on the right than on the left.All tested language paradigms produced reliable language related cortical activation. On the sentence completion paradigm, language is left dominant with Broca's area identified predominantly along the pars orbitalis, and Wernicke's area is identified along the posterior aspect of the left superior temporal sulcus. On the verb generation and word generation paradigms, Broca's area remains best visualized along the left pars orbitalis. Wernicke's area, however, is much more prominently seen along the posterior aspect of the right superior temporal sulcus with only mild Wernicke's area activity detected on the left.
Functional assessment of sensorimotor cortical activation identifies the motor strip in its customary location. Cortical activation related to lower extremity/foot motion is seen bilaterally along the high paramedian precentral gyri. Cortical activation is, if anything, more robust on the right than on the left. This discrepancy can be technical in origin, though it can also reflect increased effort related to left leg dysfunction. Given this finding, and the fact that no impinging or compressing lesions are seen at the foot motor area, the etiology of the patient's left leg dysfunction may be more distal.Functional assessment of language reveals Broca's and Wernicke's areas in their expected locations of the inferior frontal and posterior temporal lobes respectively. On one out of the three tested paradigms, language is left dominant. However, on two of the three paradigms, substantial contributions are seen from the right hemisphere, and in particular, Wernicke's area is far more robustly activated on the right than on the left. Findings would suggest that language processing is somewhat more distributed between both cerebral hemispheres than what is typically seen.