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J Neurol Surg A Cent Eur Neurosurg 2014; 75(01): 064-069
DOI: 10.1055/s-0033-1358610
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Dissociated Language Functions: A Matter of Atypical Language Lateralization or Cerebral Plasticity?

Marcus Andre Acioly
1   Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany
,
Alireza Gharabaghi
1   Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany
2   Werner Reichardt Centre for Integrative Neuroscience, Eberhard Karls University Hospital, Tübingen, Germany
,
Christoph Zimmermann
1   Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany
,
Michael Erb
3   Department of Neuroradiology, Eberhard Karls University Hospital, Tübingen, Germany
,
Stefan Heckl
3   Department of Neuroradiology, Eberhard Karls University Hospital, Tübingen, Germany
,
Marcos Tatagiba
1   Department of Neurosurgery, Eberhard Karls University Hospital, Tübingen, Germany
2   Werner Reichardt Centre for Integrative Neuroscience, Eberhard Karls University Hospital, Tübingen, Germany
› Author Affiliations
Further Information

Publication History

11 December 2012

28 June 2013

Publication Date:
19 December 2013 (online)

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Abstract

Background and Study Aims The left hemisphere is generally considered to harbor language functions. Atypical cortical language lateralization is mainly demonstrated in left-handed and ambidextrous individuals, whereas dissociated language functions have been reported in association with brain injuries as a part of the reorganization process. We present a thoughtful discussion on the underlying mechanisms of dissociated language functions through an illustrative case of dissociated expressive language.

Case Report A 31-year-old left-handed woman presented with a recurrent left frontal glioma. Preoperative language functional magnetic resonance imaging (fMRI) panel revealed right-sided dominance for two different language tasks (verbal fluency and visual naming), and the word chain task demonstrated maximal activation in the left hemisphere at the posterior margin of the tumor. The patient was operated on awake to assess language functions intraoperatively. Preoperative fMRI findings were confirmed revealing a task-specific dissociation of expressive language functions. Surgical resection was taken to the functional boundaries. Postoperatively, no language dysfunction occurred.

Conclusions Dissociated language functions are prone to occur in long-standing lesions. Different patterns of dissociation may be encountered due to interindividual particularities and cerebral plasticity. The presented patient is unique by demonstrating new insight into expressive language dissociation, emphasizing the role of a preoperative language fMRI panel and the capability of intraoperative language mapping for identifying special language networks.

Keywords

awake surgery - dissociated language function - electrical stimulations - functional brain mapping - glioma - language
 

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