Atypical language cortex in the left temporal lobe: relationship to bilateral language.

BACKGROUND: The intracarotid amobarbital procedure (IAP) is widely used in the preoperative evaluation for epilepsy surgery to lateralize language dominance and memory functions. However, language mapping has most often been accomplished with cortical brain stimulation. OBJECTIVE: To examine left temporal lobe language cortex representation using this technique in patients with bilateral language (BL) as compared with patients with left language dominance (LD). METHODS: The language maps of each patient were reviewed retrospectively. Group I consisted of 10 patients with BL and Group II consisted of 10 matched control patients with LD. Each stimulation trial included a brief assessment of confrontation naming, automatic speech, reading, repetition, and comprehension. Clusters of errors that included comprehension, repetition, and naming defined primary temporal lobe language areas. RESULTS: Mapping revealed two distinct language areas in 60% of patients in Group I and 10% in Group II (p = 0.019). In Group I, two patients had both language areas in the same gyrus (either the superior or the middle temporal gyrus), whereas two showed one language area each in the superior and middle temporal gyri and the remaining two had one in the superior temporal gyrus and the other intermixed between the superior and middle temporal gyri. In Group II, both language areas were intermixed between the superior and middle temporal gyri. CONCLUSIONS: Bilateral language (BL) representation in the intracarotid amobarbital procedure is frequently associated with more than one noncontiguous language area in the left temporal lobe. A careful search for multiple language areas, particularly in patients with BL, is prudent prior to surgical resection.

Congenital spine deformity, congenital stenosis, diastematomyelia, and tight filum terminale in a workmen's compensation patient: a case report.

STUDY DESIGN: This case report concerns a patient injured at work who was denied adequate evaluation and treatment by a Workman's Compensation Commission, resulting in nearly complete paraplegia. OBJECTIVES: For a patient with a congenital spine deformity, a diastematomyelia, a tight filum terminale, and a congenital stenosis, denial of magnetic resonance imaging evaluation and appropriate surgery cannot be justified. SUMMARY OF BACKGROUND DATA: This 35-year-old man injured his knee and back in a fall at work but was able to work for 1 week. Progressive neurologic deterioration was documented, but magnetic resonance imaging evaluation was denied. When it finally obtained and the lesion identified, appropriate neurosurgery was denied. METHODS: When seen by the authors more than 3 years after his injury, he had a nearly complete paraplegia. Despite neurosurgical decompression and spine stabilization, no significant recovery occurred. RESULTS: A nearly complete paraplegia resulted from this combination of lesions coupled with intolerable delay in diagnosis and therapy, both the result of "foot-dragging" by a Workmen's Compensation Commission. CONCLUSIONS: In an effort to be "cost-conscious" and to avoid "unnecessary low back surgery," a Workmen's Compensation Commission has caused a patient to become paraplegic. Such management is neither cost-effective nor of adequate quality.

Imaging of cerebellar surface activation in vivo using voltage sensitive dyes.

The understanding of the information processing performed by complex neuronal networks in the central nervous system will require techniques permitting the simultaneous monitoring of the electrical activity of neuronal ensembles. Voltage sensitive dyes offer the potential for non-invasive optical monitoring of the activity in large populations of neurons. In this report we describe the use of voltage sensitive dyes and image processing techniques to monitor in vivo the activation of parallel fibers and associated neuronal events produced by stimulation of the cerebellar cortex in the rat. Despite the temporal limitations of video processing a relatively brief set of neuronal events was successfully imaged. Using this methodology we demonstrate that the detected fluorescent light changes were highly correlated with the evoked extracellular field potentials. Graded surface stimulation produced graded spatial patterns consistent with known parallel fiber anatomy and physiology. The optical signals were dependent on the presence of the voltage sensitive dyes and were abolished by topical application of a local anesthetic agent. In essence, activation of a parallel fiber beam and associated activity were imaged at relatively high resolution.