title: Discrepant findings for Wada test and functional magnetic resonance imaging with regard to language function: use of electrocortical stimulation mapping to confirm results. Case report.
abstract: The Wada test is still considered the gold standard for determining the language-dominant hemisphere prior to brain surgery. The authors report on a 34-year-old right-handed woman whose Wada test results indicated that the right hemisphere was dominant for language. In contrast, functional magnetic resonance (fMR) imaging was indicative of bilaterally represented language functions. Activation in the left hemisphere demonstrated on fMR imaging was most pronounced in the Broca area. Importantly, fMR imaging results in this area were confirmed on electrocortical stimulation mapping. These contradictory findings indicated that a right hemispherre dominance for language according to the Wada test should be questioned and verified using electrocortical stimulation. Nonetheless, the question remains whether involvement of these areas in the left frontal hemisphere is critical for language, as these were spared during surgery.
authors.affiliation: Departments of Neurosurgery, Clinical Neurophysiology, and Psychiatry, Rudolf Magnus Institute of Neuroscience, University Medical Center, Utrecht, The Netherlands. k.h.kho@azu.nl
authors.forename: Kuan H
authors.initials: KH
authors.lastname: Kho
authors.forename: Frans S S
authors.initials: FS
authors.lastname: Leijten
authors.forename: Geert-Jan
authors.initials: GJ
authors.lastname: Rutten
authors.forename: Jan
authors.initials: J
authors.lastname: Vermeulen
authors.forename: Peter
authors.initials: P
authors.lastname: Van Rijen
authors.forename: Nick F
authors.initials: NF
authors.lastname: Ramsey
mesh_terms: D000328:Adult; D000654:Amobarbital; D001921:Brain / Q000378:metabolism* / Q000503:physiopathology; D001931:Brain Mapping / Q000295:instrumentation*; D004558:Electric Stimulation / Q000295:instrumentation; D004569:Electroencephalography; D004827:Epilepsy / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D018757:GABA Modulators; D006801:Humans; D007802:Language; D008279:Magnetic Resonance Imaging; D011300:Preoperative Care
chemical_list: D018757:GABA Modulators; D000654:Amobarbital