Female, 41 years old, with intractable epilepsy. Functional localization requested for presurgical evaluation. During the visual stimulation portion of the examination, the patient experienced one of her typical seizure episodes with involuntary movement of the right arm, disorientation and headache. The symptoms lasted less than 5 minutes, and after a short delay, the patient was fully recovered and able to proceed with the remainder of the exam. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical activation maps as expected along the bilateral calcarine sulci.All tested language paradigms produce reliable language related cortical activation. Language is left dominant. Multiple foci of cortical activation are observed mapping to the left inferior frontal gyrus (primarily pars opercularis and pars triangularis) which likely reflect the putative Broca's area. Foci of activation in the left posterior temporal lobe are seen variable on all language paradigms, though the sentence completion paradigm produces the most robust activation. A focus of activation is seen along the left superior temporal sulcus which is typical of the putative Wernicke's area. However, foci are also seen more posteriorly in the superior temporal gyrus and the middle temporal gyrus, which could reflect additional sites of Wernicke's processing or sites of accessory language processing.
1.Technically successful fMRI for sensorimotor and language cortical mapping.2.Sensorimotor cortical activation maps as expected along the pre- and post-central gyri. Visual cortical activation maps as expected along the calcarine sulci.3.Language is left dominant. Cortical activation related to Broca's and Wernicke's areas maps to the customary locations as above.