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NEUROLOGY 1998;50:943-950
© 1998 American Academy of Neurology

Regional cerebral blood flow and language dominance

SPECT during intracarotid amobarbital testing D. McMackin, PhD, M. Jones-Gotman, PhD, F. Dubeau, MD, J. Gotman, PhD, A. Lukban, MSc, G. Dean, PhD, A. Evans, PhD and R. Lisbona, MD

From the Department of Neurology and Neurosurgery (Drs. McMackin, Jones-Gotman, Dubeau, Gotman, and Dean), Montreal Neurological Institute, McGill University, Montreal, Quebec; and the Department of Nuclear Medicine (Drs. Evans and Lisbona and A. Lukban), Royal Victoria Hospital, Montreal, Quebec, Canada.

Address correspondence and reprint requests to Dr. Deirdre McMackin, Dept. of Clinical Neuropsychology, Beaumont Hospital, Dublin 9, Ireland.

We examined the relation between language dominance and regional cerebral blood flow (rCBF) during the intracarotid amobarbital procedure (IAP). A previous report limited to three patients suggested that dominant rather than nondominant hemisphere IAP may have a differential effect on rCBF. Behavioral assessment during the IAP also suggests that dominant hemisphere injection results in a differential effect on memory and affective symptoms rather than nondominant injection. Thirteen patients were assessed using single-photon emission CT (SPECT) brain imaging during both left and right IAP. The SPECTs were coregistered with the individual's MRI. Changes in rCBF during each IAP were compared with the patient's baseline SPECT. Nine patients had left hemisphere dominance, two were right dominant, and two had bilateral speech representation. In the left dominant subjects, left-hemisphere injection had a consistently greater effect on rCBF than right-hemisphere injection in the anterior (p < 0.005) and posterior (p < 0.01) temporal neocortex. There was also a trend for greater hypoperfusion in the frontal lobe of the left hemisphere. rCBF in the ipsilateral hippocampus was not significantly different after each injection (p < 0.05). In the two patients with right hemisphere speech, the reverse pattern was seen, with greater hypoperfusion after right (dominant) hemisphere injection. There was no consistent asymmetry in the two patients with bilateral speech. Dominant hemisphere IAP results in significantly greater hypoperfusion than dose nondominant injection. These data provide a physiologic basis for behavioral differences noted after dominant versus nondominant IAP.

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Supported by a grant from the Savoy Foundation for Epilepsy, an MRC operating grant MT-10314 to M.J.-G., Amersham International, Canada Abbott Industries, Horner Canada, and Hoescht Canada.

Received January 29, 1997. Accepted in final form October 24, 1997.

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