Male, 22 years old, with left insular brain lesion, 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. Likewise, visual cortical stimulation maps as expected along the bilateral calcarine sulci. Bilateral activation of the lateral geniculate nuclei is also seen.Of the tested language paradigms, the most reliable language related cortical activation is seen with the word generation, verb generation, and sentence completion paradigms. Language is left dominant on all tested paradigms. Broca's area is identified within the pars opercularis and pars triangularis of the inferior frontal lobe, and Wernicke's area is identified overlapping the posterior aspect of the superior temporal sulcus. Variable language contributions are noted from the right cerebral hemisphere, most prominently on the word generation and sentence completion paradigms.Regarding the positioning of functional domains relative to the patient's left insular lesion, cortical activation likely related to Broca's area is seen within the cortex immediately anterior and superior to the insular signal abnormality. Secondary language related activation is also seen within the frontal lobe operculum which sits immediately lateral to the insula.
Sensorimotor cortical activation maps as expected along the pre and postcentral gyri. Visual cortical activation maps as expected along the bilateral calcarine sulci.Language related cortical activation is left dominant with variable, paradigm dependent contributions from the right cerebral hemisphere.