40 yo female. Progressive parenchymal abnormality involving the left paracentral lobule with associated right lower extremity seizure. fMRI requested for surgical planning. There is susceptibility artifact from the recent biopsy of the lesion involving the left paracentral lobule. There is also susceptibility effect related to the overlying skull and scalp postoperative changes.There is sensorimotor cortical activation as expected along the pre- and post-central gyri bilaterally for the hand and face.Lower extremity sensorimotor cortical activation also maps as expected to the paramedian paracentral lobules. This activation is of reduced intensity on the left relative to the right. Nevertheless, activity is seen on the left and maps to the posterior edge of the lesion. No definite cortical activation is seen specifically within the lesional tissue but this does not exclude functional capacity within the lesion. Cortical activation in the supplementary motor area was present bilaterally, even somewhat accentuated on the left side of the brain.
Sensorimotor cortical activation maps as expected along the pre and postcentral gyri bilaterally.Sensorimotor cortical activation of the lower extremity is seen bilaterally though the intensity of this activation is markedly reduced on the left. This discrepancy may reflect the patient's right lower extremity clinical deficit, or it could be an artifact related to edema or lesion related neurovascular decoupling. Nevertheless, activity related to the right lower extremity maps along the posterior edge of the left paracentral lobule lesion. The presence of some functional capacity within the lesion is not excluded.