Research reportCategory-specific recognition and naming deficits following resection of a right anterior temporal lobe tumor in a patient with atypical language lateralization
Section snippets
Pre-operative neuropsychological assessment and Wada results
The patient completed a neuropsychological assessment in our laboratory approximately 1 month prior to his surgery. At that time, intellectual abilities were substantially above average, with verbal and language-related abilities somewhat stronger than those in the visual–spatial area. His level of academic knowledge was somewhat below his level of general intelligence, but still clearly above average. The patient's overall neuropsychological assessment was above average, although a small
Intraoperative language mapping
Intraoperative cortical stimulation language mapping used a standard clinical protocol of naming pictures on a computer screen, with stimuli presented at 3 sec intervals (Ojemann et al., 1989). Once a craniotomy was performed using local anesthetic field block and neuroleptoanalgesia (Silbergeld et al., 1992), the patient was awakened for language mapping. This procedure starts with the determination of an afterdischarge threshold using electrocorticography. Language mapping is performed with
Surgical parameters
Surgical resection involved the anterior TL, well anterior to the identified speech sites. Intraoperatively, the tumor appeared to involve the parahippocampus and enterorhinal cortex (anterior-inferior TL). It also involved the anteriolateral portion of the hippocampus, although it did not invade the medial border. There was a small layer of grossly normal hippocampus on the mesial border. A gross total resection of the lesion was achieved, which included much of the parahippocampus,
Post-operative neuropsychological assessment
Standard post-operative neuropsychological assessment was completed approximately 18 months after the patient underwent surgical resection of his tumor. This evaluation revealed significant declines in auditory/verbal memory functioning, with scores dropping from the superior to the average range (see Table 1 for both pre- and post-operative neuropsychological scores). Visual memory functioning also appeared significantly worse post-operatively, with some scores declining from high average to
Post-surgical category-specific recognition and naming evaluation
The patient was assessed using category-specific stimuli covering two unique (famous faces and famous landmarks) and two nonunique (animals and man-made objects) object categories. All stimuli were obtained from Damasio and colleagues, and have been well validated in a series of studies completed in their own laboratory (Tranel et al., 1997a, Tranel et al., 1997b). These stimuli have been widely used to study recognition and naming in these three categories. Visual stimuli included pictures of
Results
The patient exhibited normal recognition and naming performances on the man-made object category. His scores for both of these tasks were average in this object domain. The patient's percent accuracy scores are included in Table 2 for all object categories.
In contrast, the patient exhibited severe recognition and naming deficits for the famous faces category. As can be seen in Table 2, he performed more than 3 standard deviations (SD) below the mean of the healthy control group on both
Discussion
This patient with right-hemispheric speech lateralization exhibited both severe recognition and naming deficits for unique objects (famous faces and landmarks) and grossly normal recognition and naming performances for nonunique objects (animals and man-made objects) following resection of an anterior right TL ganglioglioma. Patients with both recognition and naming deficits for famous faces and landmarks have been rare in general, and have only been observed previously in cases with lesions
Acknowledgements
This research was supported in part by the National Institute of Neurological Disorders and Stroke (NINDS) of the National Institute of Health (NIH) (Grant Number: K23 NSO49100-01). This study was approved by the Institutional Review Board (application #05-5738-G 01) of the University of Washington Medical School, where all data were collected. We would like to thank Drs. David W. Loring and Gregory P. Lee for input regarding language lateralization issues with this patient.
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