1/54. An angiographically occult arteriovenous malformation in the medial parietal lobe presenting as seizures of medial temporal lobe origin.We present an unusual case of a patient who was diagnosed with temporal lobe epilepsy and whose seizures were reduced markedly after excision of an angiographically occult arteriovenous malformation (AVM) located in the left medial parietal lobe. A 38-year-old man had complex partial seizures characterized by motionless staring with oroalimentary and behavioral automatisms since the age of 15 years. magnetic resonance imaging (MRI) demonstrated a small lesion extending from the left posterior cingulate gyrus to the precuneus. There was no MRI evidence of mesial temporal sclerosis. Intracranial EEG recordings showed ictal onset from the left medial parietal lobe propagating to the medial temporal lobes. Clinical signs appeared when these discharges reached the temporal lobes. After excision of the lesion (which was histologically confirmed as an AVM), together with the marginal cortex, seizures were reduced significantly. Careful diagnostic evaluation of lesions such as the this one may reveal an epileptogenic lesion (zone) far from the region where scalp ictal discharges seem to arise. In our case, we hypothesize that false localization was due to propagation of ictal discharges from the parietal focus through the limbic system.- - - - - - - - - - ranking = 1keywords = cortex (Clic here for more details about this article) |
2/54. Early and delayed MR and PET changes after selective temporomesial radiosurgery in mesial temporal lobe epilepsy.We report a patient with medically refractory mesial temporal lobe epilepsy treated by gamma knife radiosurgery. In lieu of a microsurgical procedure, an entorhinoamygdalohippocampectomy was performed with a gamma knife and low marginal doses (25 Gy). The clinical and imaging studies, including CT, MR imaging, 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), and long-term follow-up MR examinations, are reported. The patient has been seizure-free since the day of treatment, with no clinical complications. MR studies accurately depicted the effect on the target structures and the transient secondary changes around them. FDG-PET scans showed decreased metabolism after gamma knife surgery throughout the anteromesial part of the epileptogenic temporal lobe. This metabolic decrease was reversible in the lateral temporal cortex. Our case suggests that gamma knife surgery is a promising tool for use as a minimally invasive approach to the treatment of epilepsy.- - - - - - - - - - ranking = 1keywords = cortex (Clic here for more details about this article) |
3/54. Partial seizures manifesting as apnea only in an adult.PURPOSE: Although several cases of apneic seizures have been reported in neonates, epileptic seizures presenting as apnea only in adults are very rare. We present a case report of a 19-year-old man with viral encephalitis and frequent episodes of apneic seizures. methods: Prolonged electroencephalograms (EEGs), respiratory monitorings, and imaging including ictal-interictal subtraction single photon emission computed tomography (SPECT) coregistered with magnetic resonance imaging (MRI) were performed. RESULTS: Ictal EEGs recorded during apneic episodes showed repetitive sharp waves or rhythmic theta activity arising from the left or right independent bitemporal region. Ictal SPECT was performed during one episode of apnea that showed ictal EEG discharges arising from the left posterior temporal area. Ictal-interictal subtraction SPECT coregistered with MRI revealed that the seizures originated from the left, posterior, midlateral temporal cortex. CONCLUSIONS: Previous studies with ictal EEG or brain stimulation suggest that apneic seizures might be mediated through the limbic and associated cortical systems. Our study reports on a very rare case of partial seizures with apnea only in an adult patient and is supported by ictal EEG and ictal-interictal subtraction SPECT coregistered with MRI.- - - - - - - - - - ranking = 1keywords = cortex (Clic here for more details about this article) |
4/54. Temporal lobe focal cortical dysplasia: MRI imaging using FLAIR shows lesions consistent with neoplasia.Focal cortical dysplasia (FCD), a form of neuronal migration disorder, is a malformative lesion of the neocortex that occurs during development of the brain. It can cause partial and generalized epilepsy. seizures occur at an early age and are often resistant to medication. Surgical resection has been found to be beneficial in these patients. Dual pathology, in the form of mesial temporal sclerosis, has been associated with FCD. At the Children's Hospital of Eastern ontario, four patients with temporal lobe FCD have recently, been identified. This paper discusses how these children presented and how they were managed, with particular emphasis on their MRI findings and differential diagnoses. In three of the four patients neuroimaging studies showed lesions consistent with a neoplastic process because of the large volume and mass effect. Radiologically, FCD may mimic the MRI appearance of tumors, such as dysembryoplastic neuroepithelial tumors, primitive neuroectodermal tumors, gangliogliomas, oligodendrogliomas, and astrocytomas. These lesions are best visualized on fluid-attenuated inversion recovery (FLAIR) imaging, a technique that has recently become applicable in the clinical setting, as we help demonstrate in this series. With better MRI capability, milder forms of FCD and microdysplasia may be distinguished.- - - - - - - - - - ranking = 1keywords = cortex (Clic here for more details about this article) |
5/54. Focal cortical dysplasia of the temporal lobe with late-onset partial epilepsy: serial quantitative MRI.We describe serial studies of focal cortical dysplasia causing temporal lobe seizures and progressive aphasia in a 54-year-old woman. Initially, MRI volumetry of the temporal lobes showed significant left cortical thickening corresponding to an elevated amino-acid uptake in the left temporoparietal and inferior frontal cortex on SPECT using 3-[123I]iodo-alpha-methyl-L-tyrosine (IMT). After 1 year there was severe shrinkage of the left temporal lobe, possibly the result of recurrent complex partial seizures.- - - - - - - - - - ranking = 1keywords = cortex (Clic here for more details about this article) |
6/54. Surgical management of intractable epilepsy associated with cerebral neurocytoma.Neuronal neoplasms of the CNS constitute a rarely encountered group of tumors. This report concerns the surgical management of seizures encountered in four cases (ranging from 2 to 10 years-of-age at onset; consisting of two males and two females) of a recently recognized morphologically unique tumor, called 'cerebral neurocytoma'. All patients were associated solely with intractable complex partial seizures. The tumor involved the temporal lobe in two cases, and the frontal in two. magnetoencephalography (MEG) clearly demonstrated an accumulation of equivalent current dipoles originating from the interictal spikes on the cortex around the tumor. On intra-operative electrocorticography (ECoG), the epileptogenic zone was topographically distinct from the region of the tumor. No definite ECoG activities were observed at the tumor site, although this tumor did consist of small mature neuronal cells. Either a complete or a subtotal resection of the tumor and the epileptogenic cortex was performed and, post-operatively, universal freedom from seizures was demonstrated in all patients. A histological examination of the epileptogenic cortex revealed the presence of minute cortical dysplasia or tumor involvement in the hippocampus. A resection of the epileptogenic cortex along with the tumor was thus found to improve the seizure outcome in patients with neurocytoma-associated epilepsy without inducing any identifiable neurological deficits attributable to the incremental resection.- - - - - - - - - - ranking = 4keywords = cortex (Clic here for more details about this article) |
7/54. Surgical treatment for intractable epilepsy caused by cavernous angioma in the temporal lobe of the dominant hemisphere--three case reports.The surgical treatment modality for intractable epilepsy with cavernous angioma in the dominant hemisphere is still unclear. Three patients with medically intractable seizures associated with cavernous angioma in the dominant hemispheric temporal lobe underwent tailored resection based on magnetic resonance (MR) imaging, single photon emission computed tomography (SPECT), electroencephalography monitoring (from scalp and sphenoidal electrodes), and neuropsychologic assessment. Epileptogenic zones were located in the area surrounding the angioma in all patients and mesial temporal dysfunction in two patients. The adjacent cortex and gliotic tissues containing hemosiderin were resected, in conjunction with either total or partial resection of the nidus. Intraoperative electrocorticography (ECoG) was then performed. Additional resection of the mesial temporal structures or multiple subpial transection was performed as indicated by the ECoG findings. All three patients have been seizure free and showed no language or cognitive deterioration for 30, 18, and 14 postoperative months, respectively, while receiving tapered antiepileptic medication. Tailored resection based on electrophysiological data, MR imaging, SPECT, and intraoperative ECoG is effective for the treatment of medically intractable seizure associated with cavernous angioma in the temporal lobe of the dominant hemisphere.- - - - - - - - - - ranking = 1keywords = cortex (Clic here for more details about this article) |
8/54. The electrocorticographic status and the extent of the cortical resection in epileptic patients.In three patients operated on for focal epilepsy small pathological lesions in the functionally important cortical regions were microsurgically extirpated. The neighbouring areas of cortex were preseved, although they showed epileptic activity on electrocorticography. The patients are seizure-free three years, two years, and nineteen months later, respectively. On the bases of these facts and experience with another 35 patients operated on for focal epilepsy the authors speculate on the relations between the pathological lesion, epileptogenic cortical area, and the relative dependence of the extent of cortical resection on the electrocorticographic status.- - - - - - - - - - ranking = 1keywords = cortex (Clic here for more details about this article) |
9/54. Pharyngeal dysesthesias as an aura in temporal lobe epilepsy associated with amygdalar pathology.PURPOSE: Pharyngeal dysesthetic auras are typically described with centrotemporal and opercular seizure-onset localizations. In this report we describe the fourth case in literature with temporal lobe seizures, apparently secondary to an amygdalar lesion on magnetic resonance imaging (MRI), presenting with prominent pharyngeal dysesthesias as the initial, or only, seizure manifestation. methods: Because of diagnostic uncertainty regarding the nature of the pharyngeal sensations, our case underwent prolonged extracranial video-EEG monitoring. RESULTS: Video-EEG information documented the epileptic origin of the dysesthesias and was concordant with the side and location of the amygdalar lesion. CONCLUSIONS: Pharyngeal dysesthetic auras may be produced by epileptic activity originating from the amygdala, and perhaps other mediotemporal structures. The underlying topography of this aura is not known with certainty, and it may reflect seizure spread from the amygdala and adjacent areas to the closely interconnected insular and opercular cortex, whose secondary activation could elicit similar sensations.- - - - - - - - - - ranking = 1keywords = cortex (Clic here for more details about this article) |
10/54. Human "memories" can be evoked by stimulation of the lateral temporal cortex after ipsilateral medial temporal lobe resection.A patient with medically intractable seizures and mesial temporal sclerosis underwent a left anterior temporal lobectomy and amygdalohippocampectomy. After 4 months, his seizures recurred and a left temporal, subdural grid of electrodes was placed to localise his seizure focus. Stimulation through the grid evoked four distinct "memories", or experiential phenomena, despite absence of the ipsilateral medial temporal lobe. To our knowledge, this is the first documented case of experiential phenomena evoked by cortical stimulation in the absence of the ipsilateral medial temporal lobe.- - - - - - - - - - ranking = 4keywords = cortex (Clic here for more details about this article) |
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