Female, 35 years old, with medically intractable right hemisphere epilepsy. Functional MRI is requested as part of epilepsy presurgical evaluation. Sensorimotor cortical activation of the hand, foot and face maps as expected along the pre- and post-central gyri. Visual cortical activation is seen extensively within the occipital lobes. Statistical thresholding on the visual paradigm is adjusted to reveal the lateral geniculate nuclei bilaterally.Most of the tested language paradigms produced reliable language related cortical activation. In general, language laterality and relative dominance varied with the language paradigm administered and the language in which the patient generated her responses. For example, in the object naming paradigm, Broca's area activation is seen bilaterally involving the pars orbitalis and to a lesser degree the pars triangularis and opercularis. When this paradigm is performed in English, a slight right-sided preference is noted, and when in Cantonese, a slight left-sided preference is seen. Wernicke's area is not specifically elicited during this paradigm, and strong symmetric bilateral secondary language activation in the middle frontal gyri and the parietal lobes is demonstrated in both languages. During the verb generation paradigm, fairly symmetric Broca's area activation is seen bilaterally in both English and Cantonese. Wernicke's area is identified in both English in Cantonese along the posterior aspect of the superior temporal sulcus. No right-sided Wernicke's activity is noted.The word generation paradigm produces a relative Broca's dominance on the right with English, and on the left with Cantonese. No definite Wernicke's area activity is seen.When the sentence completion paradigm is performed in English, a strong left dominance of Broca's and Wernicke's areas is seen. However, when performed in Cantonese, Broca's area activity was slightly right dominant, while Wernicke's area is only seen on the left.
Sensorimotor cortical activation maps as expected along the pre- and post-central gyri. Visual cortical stimulation is evident extensively in the occipital lobes, with symmetric foci of activity visualized in the dorsolateral thalami likely indicating the location of the lateral geniculate nuclei.As the patient is multi-lingual, a hybrid approach to the language paradigms was adopted such that both English and her native Cantonese were tested. Broca's and Wernicke's areas are reliably identified in their expected locations as detailed above. However, no clear hemispheric language dominance is observed. Rather, in most cases, a mild right or left hemispheric Broca's dominance is seen depending on the paradigm and language utilized. Wernicke's area is not visualized on all paradigms, but when it is seen, it is most convincingly detected on the left. Findings suggest substantial language processing in both hemispheres, with a preference for receptive language (Wernicke's) on the left. 