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Abstract Objective Selecting the language of pre-surgical neuropsychological testing (NPT), intracarotid amobarbital procedure, and intra/extra functional language mapping (ESM) in bi−/multi-lingual patients is a high-stakes neuropsychological decision point. Though a patient’s self-selection of language is an integral consideration, both patient and provider must fully understand the potential implications of language selection on a patient’s data interpretation and overall case conceptualization. Method A 26-year-old, right-handed, bilingual (L1 = Mandarin-, L2 = English-speaking) female received pre-operative NPT, Wada test, and ESM to guide resective surgery targeting medically-refractory epilepsy involving the right superior temporal gyrus (STG) and mesial (MTL) temporal lobe. All procedures were conducted in English at the patient’s request with alternate forms of verbally-mediated NPT administered in Mandarin. Results Confrontation naming and verbal fluencies were impaired in both English and Mandarin. Wada testing administered in English revealed bilateral language and greater left hemisphere memory support. Following considerable psychoeducation regarding possible functional language loss in Mandarin post-operatively, the patient agreed to ESM in L1 with auditory and picture naming disruption after right STG stimulation. Conclusion Despite strong English-language fluency, assessment in Mandarin was of critical importance, as eloquent cortices essential for tonal language production may have been resected if mapping procedures were completed in English-only, as requested. Balancing factors informed by functional and structural neuroanatomy, patient worldview, and cross-cultural neuropsychology requires a tailored, patient-centric approach to case conceptualization.
Bender et al. (Thu,) studied this question.