Male, 32 years old, right-handed, English Spanish bilingual patient who acquired both languages simultaneously as a child, presenting with intractable seizures. Functional MRI requested for surgical planning purposes. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Passive visual stimulation elicits robust cortical activation centered on the calcarine sulci bilaterally. Foci of vision related activation are also noted in the posterolateral thalami likely correlating to the lateral geniculate nuclei.Of the tested language paradigms, the most reliable language related cortical activation is seen with the English and Spanish word generation exercises, the Spanish verb generation exercise, and the English sentence completion exercise. Language is consistently left dominant when tested in both English in Spanish. Putative Broca's area activity is seen in its expected location of the left inferior frontal gyri, primarily pars articularis and pars triangularis, on all paradigms. Putative Wernicke's area activity is seen in its expected location along the posterior aspect of the left superior temporal sulcus on the English sentence completion and Spanish verb generation paradigms. Putative Wernicke's area activity is also seen somewhat more posteriorly and inferiorly, within the posterior aspect of the left middle temporal gyrus, on the Spanish and English word generation paradigms.
1. Adequate functional mapping of the sensorimotor cortex.2. Adequate visual cortical functional mapping with visualization of the lateral geniculate nuclei.3. Language is consistently left dominant when tested in both English and Spanish. Broca's area is identified in its typical location on all tested paradigms. Putative Wernicke's area activity is seen in its typical location on two of the language exercises, but it is also seen in a somewhat more posterior and inferior location on the remaining two language exercises.