Female, 14 years old, with brain AVM, fMRI for pre-surgical speech and motor assessment. Sensorimotor cortical activation of the hand and face/tongue maps as expected along the pre- and post-central gyri. Both of these areas are well removed from the site of the patient's known left posterior temporal vascular malformation. Mapping of lower extremity/foot sensorimotor cortical activation was attempted, but due to the patient's reduced lower extremity mobility, data was unreliable and therefore not shown.Of the tested language paradigms, the most reliable language related cortical activation is seen with the verb generation and sentence completion paradigms. Language is left dominant. Activity corresponding to the putative Broca's area is seen in the left inferior frontal gyrus (primarily pars opercularis). A band of activity is seen corresponding to the expected location of Wernicke's area along the superior temporal sulcus. This activity runs obliquely from anterior to posterior in close proximity to the inferior margin of the vascular malformation. A second region of activation is seen within the left angular gyrus which runs in close proximity to the posterior superior margin of the lesion. This activity is contiguous with the more typical Wernicke's activity via a band which runs along the medial margin of the lesion.
1.Sensorimotor cortical activation for the hand and face/tongue maps as expected along the pre- and post-central gyri. Data for foot/lower extremity function is unreliable due to the patient's limited lower extremity mobility.2.Language is left dominant. Broca's area is identified in its customary location of the left inferior frontal gyrus and is well removed from the patient's temporal lobe lesion.3.Typical Wernicke's area activity is identified along the posterior superior left temporal sulcus. This activity runs obliquely along, and in close proximity to, the inferior margin of the lesion.4.Language-related activity is also seen in the left angular gyrus running in close proximity to the posterior superior margin of the lesion. This activity is contiguous with the more typical Wernicke's activity via a band which runs along the medial margin of the lesion. The angular gyrus is a know site of secondary language processing and, in this regard, is not unexpected. However, the possibility that this activity may contain some Wernicke's function displaced by the lesion should also be considered. 