Language Mapping (FAS) in A Patient with Epilepsy Secondary to Bacterial Meningitis at 6 months of Age

These transverse MRI images are of a 35 year-old businessman who was normal at birth but suffered a severe case of bacterial meningitis at 6 months of age. In the ICU for one month, he recovered, but apparently infarcted his left temporal lobe with resultant focal epilepsy. He had normal developmental milestones, including speech and general intelligence, but had limited fine motor control in his right hand.

As an adult, his focal epilepsy, originating in his left temporal region, worsened and became refractory to medications. As part of his pre-surgical workup he has undergone a verbal fluency task with echoplanar BOLD fMRI. Note that during language production his right prefrontal and temporal regions are active. These findings were consistent with the WADA test, where the right and then the left hemisphere was anesthetized with amobarbital. It is hoped that a temporal lobectomy will reduce his seizure frequency without any changes in language.

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