Dario Marin

Neural convergence for language comprehension and grammatical class production in highly proficient bilinguals is independent of age of acquisition

In bilinguals, native (L1) and second (L2) languages are processed by the same neural resources that can be modulated by age of second language acquisition (AOA), proficiency level, and daily language exposure and usage. AOA seems to particularly affect grammar processing, where a complete neural convergence has been shown only in bilinguals with parallel language acquisition from birth. Despite the fact that proficiency-related neuroanatomical differences have been well documented in language comprehension (LC) and production, few reports have addressed the influence of language exposure. A still unanswered question pertains to the role of AOA, when proficiency is comparably high across languages, with respect to its modulator effects both on LC and production. Here, we evaluated with fMRI during sentence comprehension and verb and noun production tasks, two groups of highly proficient bilinguals only differing in AOA. One group learned Italian and Friulian in parallel from birth, whereas the second group learned Italian between 3 and 6 years. All participants were highly exposed to both languages, but more to Italian than Friulian. The results indicate a complete overlap of neural activations for the comprehension of both languages, not only in bilinguals from birth, but also in late bilinguals. A slightly extra activation in the left thalamus for the less-exposed language confirms that exposure may affect language processing. Noteworthy, we report for the first time that, when proficiency and exposure are kept high, noun and verb production recruit the same neural networks for L1 and L2, independently of AOA. These results support the neural convergence hypothesis.

Foreign accent syndrome: a multimodal mapping study.

The present study explored the functional neuroanatomy of Foreign Accent Syndrome (FAS) in an Italian native speaker who developed an altered speech rhythm and melody following a circumscribed tumour to the left precentral gyrus. Structural, functional, fibre tracking and intraoperative findings were combined. No signs of dysarthria, apraxia of speech, or aphasia nor other cognitive deficits were detected, except for the fact that the patient was perceived as a non-native speaker. The patient fMRI maps were compared with a control group of 12 healthy controls. During counting, sentences and pseudoword pronunciation the patient showed an additional increased sparse activation in areas around the pre/postcentral gyrus corresponding to those involved in phonation (i.e., larynx motor area). The intraoperative cortical stimulation mapping evidenced a mouth motor representation close to the tumour, a motor type of speech arrest site just below it, and anteriorly a proper speech arrest site. Our results are discussed within the current neurolinguistic models of speech production, and emphasize the importance of the primary motor cortex. We argue that this FAS case should be thought of as a disorder of the feedforward control commands, in particular of the articulator velocity and position maps which are hypothesized to lie along the caudoventral portion of the precentral gyrus.

Brain mapping: a novel intraoperative neuropsychological approach.

OBJECTIVE Awake surgery and mapping are performed in patients with low-grade tumors infiltrating functional brain areas for which the greater the resection, the longer the patient survival. However, the extent of resection is subject to preservation of cognitive functions, and in the absence of proper feedback during mapping, the surgeon may be less prone to perform an extensive resection. The object of this study was to perform real-time continuous assessment of cognitive function during the resection of tumor tissue that could infiltrate eloquent tissue. METHODS The authors evaluated the use of new, complex real-time neuropsychological testing (RTNT) in a series of 92 patients. They reported normal scoring and decrements in patient performance as well as reversible intraoperative neuropsychological dysfunctions in tasks (for example, naming) associated with different cognitive abilities. RESULTS RTNT allowed one to obtain a more defined neuropsychological picture of the impact of surgery. The influence of this monitoring on surgical strategy was expressed as the mean extent of resection: 95% (range 73%-100%). At 1 week postsurgery, the neuropsychological scores were very similar to those detected with RTNT, revealing the validity of the RTNT technique as a predictive tool. At the follow-up, the majority of neuropsychological scores were still > 70%, indicating a decrease of < 30%. CONCLUSIONS RTNT enables continuous enriched intraoperative feedback, allowing the surgeon to increase the extent of resection. In sharp contrast to classic mapping techniques, RTNT allows testing of several cognitive functions for one brain area under surgery.

A multimodal mapping study of conduction aphasia with impaired repetition and spared reading aloud

The present study explores the functional neuroanatomy of the phonological production system in an Italian aphasic patient (SP) who developed conduction aphasia of the reproduction type following brain surgery. SP presented with two peculiar features: (1) his lesion was localized in the superior temporal gyrus, just posterior to the primary auditory cortex and anterior/inferior to and neighboring the Sylvian parietal temporal (Spt) area, and (2) he presented with severely impaired repetition and spelling from dictation of words and pseudowords but spared reading-aloud of words and pseudowords. Structural, functional, fiber tracking and intraoperative findings were combined to analyze SPs pattern of performance within a widely used sensorimotor control scheme of speech production. We found a dissociation between an interrupted sector of the arcuate fasciculus terminating in STG, known to be involved in phonological processing, and a part of the arcuate fasciculus terminating in MTG, which is held to be involved in lexical-semantic processing. We argue that this phonological deficit should be interpreted as a disorder of the feedback system, in particular of the auditory and somatosensory target maps, which are assumed to be located along the Spt area. In patient SP, the spared part of the left arcuate fasciculus originating in MTG may support an unimpaired reading performance, while the damaged part of the left arcuate fasciculus originating in STG may be responsible for his impaired repetition and spelling from dictation.

Involuntary switching into the native language induced by electrocortical stimulation of the superior temporal gyrus: A multimodal mapping study

We describe involuntary language switching from L2 to L1 evoked by electro-stimulation in the superior temporal gyrus in a 30-year-old right-handed Serbian (L1) speaker who was also a late Italian learner (L2). The patient underwent awake brain surgery. Stimulation of other portions of the exposed cortex did not cause language switching as did not stimulation of the left inferior frontal gyrus, where we evoked a speech arrest. Stimulation effects on language switching were selective, namely, interfered with counting behaviour but not with object naming. The coordinates of the positive site were combined with functional and fibre tracking (DTI) data. Results showed that the language switching site belonged to a significant fMRI cluster in the left superior temporal gyrus/supramarginal gyrus found activated for both L1 and L2, and for both the patient and controls, and did not overlap with the inferior fronto-occipital fasciculus (IFOF), the inferior longitudinal fasciculus (ILF) and the superior longitudinal fasciculus (SLF). This area, also known as Stp, has a role in phonological processing. Language switching phenomenon we observed can be partly explained by transient dysfunction of the feed-forward control mechanism hypothesized by the DIVA (Directions Into Velocities of Articulators) model (Golfinopoulos, E., Tourville, J. A., & Guenther, F. H. (2010). The integration of large-scale neural network modeling and functional brain imaging in speech motor control.

Double-letter processing in surface dyslexia and dysgraphia following a left temporal lesion: A multimodal neuroimaging study.

Neuropsychological data about acquired impairments in reading and writing provide a strong basis for the theoretical framework of the dual-route models. The present study explored the functional neuroanatomy of the reading and spelling processing system. We describe the reading and writing performance of patient CF, an Italian native speaker who developed an extremely selective reading and spelling deficit (his spontaneous speech, oral comprehension, repetition and oral picture naming were almost unimpaired) in processing double letters associated with surface dyslexia and dysgraphia, following a tumor in the left temporal lobe. In particular, the majority of CFs errors in spelling were phonologically plausible substitutions, errors concerning letter numerosity of consonants, and syllabic phoneme-to-grapheme conversion (PGC) errors. A similar pattern of impairment also emerged in his reading behavior, with a majority of lexical stress errors (the only possible type of surface reading errors in the Italian language, due the extreme regularity of print-to-sound correspondence). CFs neuropsychological profile was combined with structural neuroimaging data, fiber tracking, and functional maps and compared to that of healthy control participants. We related CFs deficit to a dissociation between impaired ventral/lexical route (as evidenced by a fractional anisotropy - FA decrease along the inferior fronto-occipital fasciculus - IFOF) and relatively preserved dorsal/phonological route (as evidenced by a rather full integrity of the superior longitudinal fasciculus - SLF). In terms of functional processing, the lexical-semantic ventral route network was more activated in controls than in CF, while the network supporting the dorsal route was shared by CF and the control participants. Our results are discussed within the theoretical framework of dual-route models of reading and spelling, emphasize the importance of the IFOF both in lexical reading and spelling, and offer a better comprehension of the neurological and functional substrates involved in written language and, in particular, in surface dyslexia and dysgraphia and in doubling/de-doubling consonant sounds and letters.

A Multimodal Approach to the Treatment of Intraparenchymal Meningioma in a 7-Year-Old Boy: A Case Report

Intraparenchymal meningiomas are very rare: only 26 cases have been diagnosed in patients younger than 20 years since 1954. They can lead to preoperative differential diagnosis mistakes due to their atypical neuroimaging appearance. A multimodal approach is thus necessary to plan a surgical procedure aiming to receive the best extent of resection while preserving the patient’s functional integrity. The authors report the case of a 7-year-old boy with a history of blurred vision, left eye deviation, and weakness on the left side of his body. Magnetic resonance imaging (MRI) revealed an intra-axial, cortical, right parietal lesion without dural attachment. MR spectroscopy and perfusion study were obtained. Since the patient was 100% left-handed, functional MRI, diffusion tensor imaging, and neuropsychological evaluation were performed before the surgical procedure. Histopathological analysis revealed the mass to be an atypical meningioma (WHO grade II). Postoperative MRI indicated complete macroscopic lesion removal. The postsurgical neuropsychological profile was not different from the profile before surgery. The boy was discharged 3 days after the surgical operation without any neurological deficits.

Neuropsychology in Insular Lesions Prior-During and After Brain Surgery

The insula can be affected by both low- and high-grade gliomas. Due to its location and its functional integration role, resection of the insula tumors has traditionally been viewed as hazardous (Jones, Ward and Critchley, J Neurol Neurosurg Psychiatry 81:611–8, 2010). In particular, their tendency to spread along the intricate network of afferent and efferent connections between the insula itself and the surrounding cortical areas constitutes a major difficulty in reaching a gross total resection (Skrap, et al. Neurosurgery 70:1081–93, 2011). Neuropsychological evaluation is mandatory and should encompass, due to the multimodal nature of this areas, a wide range of tasks. Here we present our approach and experience with neuropsychological assessment during, prior, and after surgery. In particular, we describe a real-time neuropsychological testing administered during resection of insular gliomas in two exemplificative cases with lesions involving the left and the right hemisphere.

Design fluency and neuroanatomical correlates in 54 neurosurgical patients with lesions to the right hemisphere

We addressed the neuroanatomical correlates of 54 right-brain-damaged neurosurgical patients on visuo-spatial design fluency, which is a measure of the ability to generate/plan a series of new abstract combinations in a flexible way. 22.2% of the patients were impaired. They failed the task because they did not use strategic behavior, in particular they used rotational strategy to a significantly lower extent and produced a significantly higher rate of perseverative errors. Overall performance did not correlate with neuropsychological tests, suggesting that proficient performance was independent of other cognitive domains. Performance significantly correlated with use of rotational strategy. Tasks related to executive functions such as psychomotor speed and capacity to shift were positively correlated to the number of strategies used to solve the task. Lesion analysis showed that the maximum density of the patients’ lesions—obtained by subtracting the overlap of lesions of spared patients from the overlap of lesions of impaired patients—overlaps with the precentral gyrus, rolandic operculum/insula, superior/middle temporal gyrus/hippocampus and, at subcortical level, with part of the superior longitudinal fasciculus, external capsule, retrolenticular part of the internal capsule and sagittal stratum (inferior longitudinal fasciculus and inferior fronto–occipital fasciculus). These areas are part of the fronto–parietal–temporal network known to be involved in top–down control of visuo-spatial attention, suggesting that the mechanisms and the strategies needed for proficient performance are essentially visuo-spatial in nature.