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Left hemispheric neuronal heterotopia

A PET, MRI, EEG, and neuropsychological investigation of a university student

Department of Neurology (P. Calabrese and Drs. Durwen, Gehlen, and Haupts) of the Ruhr-University Clinic Bochum (Knappschaftskrankenhaus), Bochum, the Max-Planck-Institute for Neurological Research (Drs. Fink and Kessler), Cologne, and the Section of Physiological Psychology of the University of Bielefeld (P. Calabrese and J. Liess, and Dr. Markowitsch), Bielefeld, Germany.

A 21-year-old left-handed medical student had a prominent unilateral cerebral cortical malformation due to an ontogenetic migration disorder. We performed neuropsychological studies, EEG, T¹ and T²-weighted and proton-density MRI, and positron emission tomography (PET) (under both the resting condition and neuropsychological activation). Neuropsychological testing revealed normal intelligence and generally normal memory functioning but selective deficits in tests of verbal fluency and spatial-figural relationships. Proton-density and T2-weighted MRI revealed extensive left cortical heterotopia that included parts of the Wernicke area. PET under the resting condition revealed a small interhemispheric difference with slightly reduced glucose metabolism in the left temporoparietal cortical zone. An activation PET (with the patient performing a verbal fluency test) resulted in a normal overall increase in metabolism but marked deviations in cortical areas. The highest activity changes were in the Broca and Wernicke areas of the right hemisphere, and there was very little activation in those regions of the left hemisphere that were expected to respond well to the activation–the temporal, parietal, and temporo-occipital cortical zones. We conclude that there can be large compensations for unilateral heterotopia.

Address correspondence and reprint requests to P. Calabrese, Department of Neurology (Knappschaftskrankenhaus), In der Schornau 23-25, D-44892 Bochum, Germany.

Supported by grant Ma 795/9-3 from the German Research Council (DFG).

Received February 22, 1993. Accepted for publication in final form August 6, 1993.

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