Language supplementary motor area syndrome correlated with dynamic changes in perioperative task-based functional MRI activations: case report

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  • 1 Departments of Neurosurgery,
  • 2 Neuroradiology, and
  • 3 Imaging Physics, University of Texas MD Anderson Cancer Center; and
  • 4 Department of Neuro-Oncology, Section of Neuropsychology, University of Texas MD Anderson Cancer Center, Houston, Texas
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Supplementary motor area (SMA) syndrome is well known; however, the mechanism underlying recovery from language SMA syndrome is unclear. Herein the authors report the case of a right-handed woman with speech aphasia following resection of an oligodendroglioma located in the anterior aspect of the left superior frontal gyrus. The patient exhibited language SMA syndrome, and functional MRI (fMRI) findings 12 days postoperatively demonstrated a complete shift of blood oxygen level–dependent (BOLD) activation to the contralateral right language SMA/pre-SMA as well as coequal activation and an increased volume of activation in the left Broca’s area and the right Broca’s homolog. The authors provide, to the best of their knowledge, the first description of dynamic changes in task-based hemispheric language BOLD fMRI activations across the preoperative, immediate postoperative, and more distant postoperative settings associated with the development and subsequent complete resolution of the clinical language SMA syndrome.

ABBREVIATIONS BOLD = blood oxygen level–dependent; DTI = diffusion tensor imaging; fMRI = functional MRI; SMA = supplementary motor area.

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Contributor Notes

Correspondence Vinodh A. Kumar: University of Texas MD Anderson Cancer Center, Houston, TX. vakumar@mdanderson.org.

INCLUDE WHEN CITING Published online June 5, 2020; DOI: 10.3171/2020.4.JNS193250.

Disclosures Dr. Wefel is a consultant for Angiochem, Bayer, Juno, Novocure, and Vanquish Oncology.

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