Female, 10 years old, left-handed, with drug resistant epilepsy, planning for epilepsy surgery. Functional MRI requested for localization of speech, vision and motor areas. As discussed above, excessive motion artifact renders the finger tapping paradigm unreliable. Sensorimotor cortical activation of the foot and face, however, is well visualized and maps as expected along the pre- and post-central gyri. The passive visual stimulation paradigm produces robust cortical activation within the bilateral occipital lobes at the level of the calcarine sulci.Of the tested language paradigms, only one of the sentence completion exercises and two verb generation exercises produce reliable language related cortical activation. The cleanest language related cortical activation is seen with the sentence completion paradigm, where language related cortical activation is seen bilaterally. Broca's area activation is noted within the inferior frontal lobe (primarily pars opercularis and pars triangularis), and Wernicke's area activation is seen within the posterior superior temporal gyri. On the verb generation paradigms, Broca's area activity is again seen though with a slight predominance on the right. Wernicke's area activation is seen bilaterally but without a consistent hemispheric dominance. Of note, on each of the language paradigms, there is bilateral activation along the lower aspect of the precentral gyrus which likely reflects facial motion during the paradigm.
Motion degradation prevents accurate demonstration of the hand sensorimotor cortical area. However, sensorimotor cortical activation of the foot and face maps as expected along the pre and post-central gyri. Visual stimulation likewise produces cortical activation in the expected location of the bilateral occipital lobes.Language related cortical activation is reliably visualized on only three of the numerous paradigm attempts. Broca's area is evident within the inferior frontal gyrus, and Wernicke's area is seen within the posterior superior temporal gyrus, each in their customary locations. Broca's area activation is seen bilaterally, with a slight right-sided predominance on two of the paradigms. Wernicke's area activation is also bilateral, but not consistently right or left dominant. Overall findings suggest that language function is shared between the hemispheres, with perhaps a slight right-sided predominance during certain language tasks.