Freiburg Neuropathology Case Conference: a Medial Temporal Lobe Lesion

Excerpt

A 53-year-old woman presenting symptomatic epilepsy with simple and complex partial seizures since the age of 13 years was referred to our hospital for epilepsy surgery. Presurgical epileptic work-up had included electroencephalography monitoring, neuropsychological investigations, fluorodeoxyglucose positron emission tomography, and neuroradiologic evaluation. Magnetic resonance imaging (MRI) of the brain showed a lesion of the left medial temporal lobe (Fig. 1, 2). Based on the results of presurgical evaluation, two-thirds resection of the temporal lobe with amygdalohippocampectomy was suggested. Epilepsy surgery was performed via a left frontotemporal approach with progressive removal of the lateral temporal cortex. During surgery, the hippocampus appeared very hard with dorsal calcifications. The arachnoid overlying the brainstem was abnormally thick and extremely adherent. However, the temporomesial mass could finally be resected in toto. Postoperative neurological examination revealed a slight hemiparesis and a hemianopsia. The computed tomography (CT) scan demonstrated a small dorsal thalamic infarction (not shown). The hemiparesis normalized during the following days. …