Category-specific naming deficit identified by intraoperative stimulation mapping and postoperative neuropsychological testing

Case report

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✓ Category-specific naming deficits and differential brain activation patterns have been reported in patients naming living as opposed to nonliving objects. The authors report on a case in which they used preoperative functional magnetic resonance (fMR) imaging, intraoperative electrocortical stimulation mapping (ESM), and postoperative neuropsychological testing to map language function. Using the latter two modalities, the authors identified a specific locus for category-specific naming in the posterior inferior temporal lobe, presumably a part of the basal temporal language area. Preoperative fMR imaging findings revealed the presence of a language area in the inferior temporal lobe; intraoperative ESM results indicated that this cortical area may be category specific for living objects; and after resection of the area, the results of postoperative neuropsychological testing confirmed that the patient made significantly more errors while naming living objects compared with nonliving ones (p < 0.001), independent of the effects of word frequency and with an intact system of object recognition and comprehension. These authors are the first to identify a specific and well-localized area of category-specific naming in the inferior temporal lobe and to demonstrate congruence of intraoperative and postoperative category-specific naming deficits. They also emphasize the roles of preoperative and intraoperative testing in predicting clinical outcomes.

Article Information

Address reprint requests to: Arthur W. Toga, Ph.D., Laboratory of Neuro Imaging, 710 Westwood Plaza, Room 4238, Los Angeles, California 90095–1769. email: toga@loni.ucla.edu.

© AANS, except where prohibited by US copyright law.

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Figures

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    Correlation of electrocortical stimulation maps and fMR image activations. A: Image of intraoperative cortical exposure with sterile tags highlighted and arranged in a grid. The exposure included areas of the temporal lobe mostly. The asterisk between Tags 5 and 6 indicates the cortical area that, when stimulated, caused a category-specific naming deficit. B: Image of the cortical exposure with ESM tags projected onto the patient's cortical model. The asterisk again indicates the cortical area of interest with category-specific naming deficits. C: Two BOLD fMR image activations projected onto a three-dimensional cortical model of the patient's brain. Left: The red areas demonstrate cortical activations for language expression maps. Right: The blue areas demonstrate cortical activations for language comprehension maps. Both expression and comprehension maps demonstrate fMR imaging activity adjacent to the area of interest, which is marked by asterisks. The plus signs indicate other areas associated with language disruption during intraoperative ESM (not related to the category-specific naming deficit). D: Images of selected slices demonstrating both language expression (red areas) and comprehension (blue areas) maps. Both language expression and comprehension demonstrate functional activations in the motor strip and supplementary motor area (Slice 1), pars opercularis (Slice 2), and adjacent to the area of interest (indicated by the asterisk in Slice 3). In addition, language comprehension maps (blue areas in Slice 2) demonstrate functional activations colocalizing with cortical areas associated with intraoperative language disruption by ESM (indicated by the plus sign in Slice 2). These activations do not appear on the three-dimensional cortical model because the activations do not extend out to the surface.

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    Preoperative and postoperative images. A: Preoperative T1-weighted MR images with contrast enhancement demonstrating a nonenhancing mass in the left inferior temporal lobe. The asterisk indicates the cortical area of interest with category-specific naming deficits. B: Postoperative T1-weighted MR images with contrast enhancement demonstrating the extent of tumor resection in the left temporal lobe, including the middle and inferior temporal gyri, the fusiform gyrus, the parahippocampal gyrus, and the hippocampus. The asterisk demonstrates that the cortical area of interest with category-specific naming deficits was included in the resection.

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