Crossed aphasia elicited by intraoperative cortical and subcortical stimulation in awake patients.
ABSTRACT Crossed aphasia (aphasia resulting from a right hemispheric lesion among right-handed patients) is rare. The authors describe for the first time transient crossed aphasia elicited by intraoperative electrostimulation of both cortex and white matter pathways in awake patients.
Three right-handed adults underwent surgery for a right-sided glioma. Because slight language disorders occurred during partial seizures or were identified on preoperative cognitive assessment, with right activations detected on language functional MR imaging in 1 patient, awake craniotomy was performed using intraoperative cortico-subcortical electrical functional mapping.
Transient language disturbances were elicited by stimulating discrete cortical areas (inferior frontal gyrus and posterior part of the superior temporal gyrus) and white matter pathways (inferior frontooccipital fasciculus and arcuate fasciculus). A subtotal resection was achieved in all cases, according to functional boundaries. Postoperatively, 1 patient experienced a transient dysphasia, which resolved after speech rehabilitation, with no permanent deficit.
These original findings highlight the possibility of finding crucial cortico-subcortical language networks in the right hemisphere in a subgroup of atypical right-handed patients. These findings provide new insights into the neural basis of language, by underlining the role of the right inferior occipitofrontal fasciculus in semantics and that of the right arcuate fasciculus in phonology, and by supporting the hypothesis of a mirror organization between the right and left hemispheres. The authors suggest that, in right-handed patients, if language disturbances are detected during seizures or on presurgical neuropsychological assessment, especially when right activations are observed on language functional MR imaging, awake craniotomy with intraoperative language mapping should be considered.
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ABSTRACT: While the left-hemispheric dominance for language in most right-handers is unquestionable, clinical observations suggest that the right, nondominant hemisphere has a considerable capacity for language. Under certain neuroanatomical conditions, the right-hemispheric capacity becomes functional and, thus, measurable. This study focuses on evoked language responses during electrical stimulation of the right hemisphere in three left-dominant patients undergoing temporal lobe resections for medically intractable seizures.Brain and Language 10/1984; 23(1):159-66. · 3.39 Impact Factor
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ABSTRACT: Audio recordings of the speech of seven patients receiving cortical stimulation during epilepsy surgery were acoustically analyzed, and duration measurements of the sound /s/ under stimulation and nonstimulation conditions were compared. It was found that in the dominant hemisphere, stimulation tended to significantly increase the duration of /s/; but not all stimulation sites were comparably affected. Stimulation of frontal lobe locations was also observed to more frequently result in durational increases than when temporal or parietal sites were stimulated. However, for sites affected, the actual magnitude of durational increase was comparable among the three lobes.Brain and Language 06/1980; 10(1):89-97. · 3.39 Impact Factor