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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
 

  • References

  • 1 Eling P, Whitaker H. Chapter 36: history of aphasia: from brain to language. Handb Clin Neurol 2010; 95: 571-582
    PubMedGoogle Scholar
  • 2 Pujol J, Deus J, Losilla JM, Capdevila A. Cerebral lateralization of language in normal left-handed people studied by functional MRI. Neurology 1999; 52 (5) 1038-1043
    CrossrefPubMedGoogle Scholar
  • 3 Rasmussen T, Milner B. The role of early left-brain injury in determining lateralization of cerebral speech functions. Ann N Y Acad Sci 1977; 299: 355-369
    CrossrefPubMedGoogle Scholar
  • 4 Smits M, Visch-Brink E, Schraa-Tam CK, Koudstaal PJ, van der Lugt A. Functional MR imaging of language processing: an overview of easy-to-implement paradigms for patient care and clinical research. Radiographics 2006; 26 (Suppl. 01) S145-S158
    CrossrefPubMedGoogle Scholar
  • 5 Szaflarski JP, Binder JR, Possing ET, McKiernan KA, Ward BD, Hammeke TA. Language lateralization in left-handed and ambidextrous people: fMRI data. Neurology 2002; 59 (2) 238-244
    CrossrefPubMedGoogle Scholar
  • 6 Petrovich NM, Holodny AI, Brennan CW, Gutin PH. Isolated translocation of Wernicke's area to the right hemisphere in a 62-year-man with a temporo-parietal glioma. AJNR Am J Neuroradiol 2004; 25 (1) 130-133
    PubMedGoogle Scholar
  • 7 Binder JR, Frost JA, Hammeke TA, Cox RW, Rao SM, Prieto T. Human brain language areas identified by functional magnetic resonance imaging. J Neurosci 1997; 17 (1) 353-362
    PubMedGoogle Scholar
  • 8 Buckner RL, Raichle ME, Petersen SE. Dissociation of human prefrontal cortical areas across different speech production tasks and gender groups. J Neurophysiol 1995; 74 (5) 2163-2173
    PubMedGoogle Scholar
  • 9 Baciu MV, Watson JM, McDermott KB , et al. Functional MRI reveals an interhemispheric dissociation of frontal and temporal language regions in a patient with focal epilepsy. Epilepsy Behav 2003; 4 (6) 776-780
    CrossrefPubMedGoogle Scholar
  • 10 Holodny AI, Schulder M, Ybasco A, Liu WC. Translocation of Broca's area to the contralateral hemisphere as the result of the growth of a left inferior frontal glioma. J Comput Assist Tomogr 2002; 26 (6) 941-943
    CrossrefPubMedGoogle Scholar
  • 11 Kamada K, Takeuchi F, Kuriki S, Todo T, Morita A, Sawamura Y. Dissociated expressive and receptive language functions on magnetoencephalography, functional magnetic resonance imaging, and amobarbital studies. Case report and review of the literature. J Neurosurg 2006; 104 (4) 598-607
    CrossrefPubMedGoogle Scholar
  • 12 Ries ML, Boop FA, Griebel ML , et al. Functional MRI and Wada determination of language lateralization: a case of crossed dominance. Epilepsia 2004; 45 (1) 85-89
    CrossrefPubMedGoogle Scholar
  • 13 Vikingstad EM, George KP, Johnson AF, Cao Y. Cortical language lateralization in right handed normal subjects using functional magnetic resonance imaging. J Neurol Sci 2000; 175 (1) 17-27
    CrossrefPubMedGoogle Scholar
  • 14 Duffau H. New concepts in surgery of WHO grade II gliomas: functional brain mapping, connectionism and plasticity—a review. J Neurooncol 2006; 79 (1) 77-115
    CrossrefPubMedGoogle Scholar
  • 15 Huber W, Poeck K, Weniger D , et al. Aachener Aphasie Test (AAT). Göttingen, Germany: Hogrefe; 1983
    Google Scholar
  • 16 Staudt M, Grodd W, Niemann G, Wildgruber D, Erb M, Krägeloh-Mann I. Early left periventricular brain lesions induce right hemispheric organization of speech. Neurology 2001; 57 (1) 122-125
    CrossrefPubMedGoogle Scholar
  • 17 Snodgrass JG, Vanderwart M. A standardized set of 260 pictures: norms for name agreement, image agreement, familiarity, and visual complexity. J Exp Psychol Hum Learn 1980; 6 (2) 174-215
    CrossrefPubMedGoogle Scholar
  • 18 Gaillard WD, Balsamo L, Xu B , et al. fMRI language task panel improves determination of language dominance. Neurology 2004; 63 (8) 1403-1408
    CrossrefPubMedGoogle Scholar
  • 19 Hamberger MJ, Goodman RR, Perrine K, Tamny T. Anatomic dissociation of auditory and visual naming in the lateral temporal cortex. Neurology 2001; 56 (1) 56-61
    CrossrefPubMedGoogle Scholar
  • 20 Hamberger MJ, Seidel WT. Auditory and visual naming tests: normative and patient data for accuracy, response time, and tip-of-the-tongue. J Int Neuropsychol Soc 2003; 9 (3) 479-489
    PubMedGoogle Scholar
  • 21 Berger MS, Ojemann GA, Lettich E. Neurophysiological monitoring during astrocytoma surgery. Neurosurg Clin N Am 1990; 1 (1) 65-80
    PubMedGoogle Scholar
  • 22 Berger MS, Ojemann GA. Intraoperative brain mapping techniques in neuro-oncology. Stereotact Funct Neurosurg 1992; 58 (1–4) 153-161
    CrossrefPubMedGoogle Scholar
  • 23 Duffau H, Capelle L, Denvil D , et al. Usefulness of intraoperative electrical subcortical mapping during surgery for low-grade gliomas located within eloquent brain regions: functional results in a consecutive series of 103 patients. J Neurosurg 2003; 98 (4) 764-778
    CrossrefPubMedGoogle Scholar
  • 24 Berger MS, Deliganis AV, Dobbins J, Keles GE. The effect of extent of resection on recurrence in patients with low grade cerebral hemisphere gliomas. Cancer 1994; 74 (6) 1784-1791
    CrossrefPubMedGoogle Scholar
  • 25 Skirboll SS, Ojemann GA, Berger MS, Lettich E, Winn HR. Functional cortex and subcortical white matter located within gliomas. Neurosurgery 1996; 38 (4) 678-684 ; discussion 684–685
    CrossrefPubMedGoogle Scholar
  • 26 Thulborn KR, Carpenter PA, Just MA. Plasticity of language-related brain function during recovery from stroke. Stroke 1999; 30 (4) 749-754
    CrossrefPubMedGoogle Scholar
  • 27 Desmurget M, Bonnetblanc F, Duffau H. Contrasting acute and slow-growing lesions: a new door to brain plasticity. Brain 2007; 130 (Pt 4) 898-914
    PubMedGoogle Scholar
  • 28 Abo M, Senoo A, Watanabe S , et al. Language-related brain function during word repetition in post-stroke aphasics. Neuroreport 2004; 15 (12) 1891-1894
    CrossrefPubMedGoogle Scholar
  • 29 Calvert GA, Brammer MJ, Morris RG, Williams SC, King N, Matthews PM. Using fMRI to study recovery from acquired dysphasia. Brain Lang 2000; 71 (3) 391-399
    CrossrefPubMedGoogle Scholar
  • 30 Fernandez B, Cardebat D, Demonet JF , et al. Functional MRI follow-up study of language processes in healthy subjects and during recovery in a case of aphasia. Stroke 2004; 35 (9) 2171-2176
    CrossrefPubMedGoogle Scholar
  • 31 Alkadhi H, Kollias SS, Crelier GR, Golay X, Hepp-Reymond MC, Valavanis A. Plasticity of the human motor cortex in patients with arteriovenous malformations: a functional MR imaging study. AJNR Am J Neuroradiol 2000; 21 (8) 1423-1433
    PubMedGoogle Scholar
  • 32 Carpentier AC, Constable RT, Schlosser MJ , et al. Patterns of functional magnetic resonance imaging activation in association with structural lesions in the rolandic region: a classification system. J Neurosurg 2001; 94 (6) 946-954
    CrossrefPubMedGoogle Scholar
  • 33 Duffau H. Lessons from brain mapping in surgery for low-grade glioma: insights into associations between tumour and brain plasticity. Lancet Neurol 2005; 4 (8) 476-486
    CrossrefPubMedGoogle Scholar
  • 34 Detre JA. Clinical applicability of functional MRI. J Magn Reson Imaging 2006; 23 (6) 808-815
    CrossrefPubMedGoogle Scholar
  • 35 Duffau H, Lopes M, Arthuis F , et al. Contribution of intraoperative electrical stimulations in surgery of low grade gliomas: a comparative study between two series without (1985–96) and with (1996–2003) functional mapping in the same institution. J Neurol Neurosurg Psychiatry 2005; 76 (6) 845-851
    CrossrefPubMedGoogle Scholar
  • 36 Roux FE, Boulanouar K, Lotterie JA, Mejdoubi M, LeSage JP, Berry I. Language functional magnetic resonance imaging in preoperative assessment of language areas: correlation with direct cortical stimulation. Neurosurgery 2003; 52 (6) 1335-1345 ; discussion 1345–1347
    CrossrefPubMedGoogle Scholar
  • 37 Rutten GJ, Ramsey NF, van Rijen PC, Noordmans HJ, van Veelen CW. Development of a functional magnetic resonance imaging protocol for intraoperative localization of critical temporoparietal language areas. Ann Neurol 2002; 51 (3) 350-360
    CrossrefPubMedGoogle Scholar
  • 38 Roder C, Bender B, Ritz R , et al. Intraoperative visualization of residual tumor: the role of perfusion-weighted imaging in a high-field intraoperative magnetic resonance scanner. Neurosurgery 2013; 72 (2, Suppl Operative): ons151-ons158 ; discussion ons158
    PubMedGoogle Scholar