BACKGROUND AND PURPOSE We describe a left-handed patient with transient aphasia and bilateral carotid stenosis. Computed tomography (CT) arteriography showed a 90% stenosis of the right and 30% stenosis of the left internal carotid artery. Head CT and magnetic resonance imaging (MRI) of the brain showed no recent ischemic changes. As only the symptomatic side would require surgical intervention, and because hemispheric dominance for language in left-handed patients may be either left or right sided, a preoperative assessment of hemispheric dominance was required. METHODS We used functional MRI to determine hemispheric dominance for language and hence to establish the indication for carotid endarterectomy surgery. RESULTS Functional MRI demonstrated right hemispheric dominance for language and right-sided carotid endarterectomy was performed. CONCLUSIONS We propose that the clinical use of functional MRI as a noninvasive imaging technique for the assessment of hemispheric language dominance may be extended to the assessment of hemispheric language dominance prior to carotid endarterectomy.

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Keywords endarterectomy, fMRI, functional laterality, language
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Note Accepted for publication in January 2010