Atypical language lateralization and contralateral epileptiform activity in a right-handed patient with a left frontal cortical lesion: A multimodal presurgical evaluation

Background: Adult-onset epilepsy due to intracranial focal lesions in one hemisphere mostly results in language function lateralization to the contralateral hemisphere. However, cortical reorganization in certain cases has led to atypical lateralization patterns. In view of this variability, comprehensive presurgical diagnostics and planning have proven to be essential in preventing postoperative complications. Case Description: We report a clinically significant case of a right-handed 40-year-old male presenting with new-onset focal epilepsy secondary to a small, nonenhancing expansile lesion in the left middle frontal gyrus. Multimodal presurgical workup revealed atypical right hemisphere language dominance and interictal epileptiform discharges over the contralateral right temporal region, raising unique considerations for surgical planning. Conclusion: This case highlights the value of integrated functional magnetic resonance imaging and electroencephalography assessment in epilepsy surgery, especially in the context of cortical reorganization.