Isolated translocation of Wernicke's area to the right hemisphere in a 62-year-man with a temporo-parietal glioma

Abstract

We describe a case of translocation of temporo-parietal language function (Wernicke's area) to the contralateral hemisphere in a right-handed patient with a left temporo-parietal glioma. This translocation was identified by functional MR imaging (fMRI) and validated by direct cortical stimulation during gross-total resection. The current case exemplifies how preoperative fMRI can identify unexpected language organization as a result of tumor growth, affording surgery to patients who may otherwise be deemed inoperable.

Fig 1.

Postcontrast left sagittal image from a 62-year-old right-handed man, showing a mostly nonenhancing temporo-parietal neoplasm involving superior temporal gyrus and portions of the supramarginal and angular gyri and underlying white matter, the expected location of Wernicke’s area.

Fig 2.

Axial fMRI results showing Broca’s area in the left hemisphere and activity most consistent with Wernicke’s area in the right hemisphere. The figure shows voxels at a correlation coefficient of 0.46 (P = 4.0 × 10⁻⁶) or higher. The language map is shown at this correlation coefficient, because it was the most robust representation of language activity in both hemispheres while minimizing the noise that would be seen at even lower thresholds.