Female, 53 years old, with CCM and intractable epilepsy, fMRI for surgical planning. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical stimulation maps as expected along the bilateral calcarine sulci.Of the tested language paradigms, the most reliable language related cortical activation is seen with the verb generation, sentence completion and rhyming paradigms. Language is left dominant. Broca's area activity is seen within the left inferior frontal gyrus, primarily pars opercularis and pars triangularis. Foci of activity favored to reflect Wernicke's are seen along the posterior aspect of the left superior temporal sulcus, and just cranially at the posterior margin of the sylvian fissure. These foci are lateral and posterior to the patient's left temporal lesion. Although not in the most typical location for Wernicke's area, they are consistently seen on each language paradigm, and no other likely candidates for Wernicke's area are identified. Please note that as the left temporal lesion induces a large area of susceptibility artifact and signal void, the immediate surrounding parenchyma cannot be accurately assessed with functional MRI. As such, the presence of some functional activity immediately adjacent to the lesion cannot be excluded.
Technically successful functional MRI for sensorimotor and language mapping. The sensorimotor and visual cortices are well delineated. Language is left dominant. Broca's area is seen in its customary location. Wernicke's area is also likely visualized with foci of activation located lateral and posterior to the patient's left temporal lesion.