Abstract
Early brain damage may induce alternative organisation of cortical brain functions.
This may happen even if there is no damage to the cortex. We assessed a 15-year-old
girl with a perinatal left-sided subcortical lesion without cortical damage by functional
MRI at 3 Tesla. The patient had congenital hemiparesis, mirrored limb movements and
normal language function. Functional MRI was used to assess language using orthographic-lexical
retrieval and noun-verb generation tasks, and demonstrated right-sided language dominance.
Functional MRI of motor function was assessed for both hands separately, by squeezing
a rubber balloon. Both hand movements induced asymmetric bilateral activation of the
motor cortex, with a predominance of contralateral activation. Language-associated
activity is usually left-hemispheric, but was found in the undamaged right-sided hemisphere.
Motor function was associated with the unusual pattern of bilateral cortical activation.
The MR findings explain the clinical features and suggest widespread alternative cortical
organisation in the presence of a focal lesion confined to subcortical structures.
Key words
Cerebral Palsy - Functional MRI - Language - Hemiparesis
References
- 1
Balbi P, Trojano L, Ragno M, Perretti A, Santoro L.
Patterns of motor control reorganisation in a patient with mirror movements.
Clin Neurophysiol.
2000;
111
318-325
- 2
Carr l J, Harrison L M, Evans A L, Stephens J A.
Patterns of central motor reorganization in hemiplegic cerebral palsy.
Brain.
1993;
116
1223-1247
- 3
Cincotta M, Borgheresi A, Liotta P, Montigiani A, Marin E, Zaccara G. et al .
Reorganisation of the motor cortex in a patient with congenital hemiparesis and mirror
movements.
Neurology.
2000;
55
129-131
- 4
Duchowny M, Jayakar P, Harvey A S, Resnick T, Alvarez L, Dean P. et al .
Language cortex representation: effects of developmental versus acquired pathology.
Ann Neurol.
1996;
40
31-38
- 5
Krams M, Quinton R, Mayston M J, Harrison L M, Dolan R J, Bouloux P-MG. et al .
Mirror movements in X-linked Kallmann's syndrome, 2. A PET study.
Brain.
1997;
120
1217-1228
- 6
Lee B, Kuppusamy K, Grueneich R, El-Ghazzawy O, Gordon R, Lin W. et al .
Hemispheric language dominance in children demonstrated by functional magnetic resonance
imaging.
J Child Neurol.
1998;
14
78-82
- 7
Leinsinger G L, Heiss D T, Jassoy A G, Pfluger T, Hahn K, Danek A.
Persistent mirror movements: functional MR imaging of the hand motor cortex.
Radiology.
1997;
203
545-552
- 8
Staudt M, Grodd W, Niemann G, Wildgruber D, Erb M, Kraegeloh-Mann I.
Early left periventricular brain lesions induce right hemispheric organization of
speech.
Neurology.
2001;
57
1122-1125
- 9
Vargha-Khadem F, O'Gorman A M, Watters G V.
Aphasia and handedness in relation to hemispheric side, age, injury and severity of
cerebral lesion during childhood.
Brain.
1985;
108
677-696
- 10
Woods R P, Dodrill C B, Ojemann G A.
Brain injury, handedness, and speech lateralization in a series of amobarbital studies.
Ann Neurol.
1988;
23
510-518
Prof. Graeme Jackson
Brain Research Institute, Neurosciences Building, A & RMC
Repatriation Campus
Banksia Street West Heidelberg
Victoria, 3081
Australia
Email: BRI@brain.org.au
