Frontiers in Neurology (Feb 2021)

Case Report: Late-Onset Temporal Lobe Epilepsy Following Subarachnoid Hemorrhage: An Interplay Between Pre-existing Cortical Development Abnormality and Tissue Damage

  • Anna Ikawa,
  • Anna Ikawa,
  • Ayataka Fujimoto,
  • Ayataka Fujimoto,
  • Yoshifumi Arai,
  • Yoshiro Otsuki,
  • Toshiki Nozaki,
  • Shimpei Baba,
  • Keishiro Sato,
  • Hideo Enoki

DOI
https://doi.org/10.3389/fneur.2021.599130
Journal volume & issue
Vol. 12

Abstract

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Epileptogenicity following brain insult depends on various factors including severity of the resulting lesion and extent of brain damage. We report a 54-year-old female patient who developed medically refractory epilepsy resulting from the interplay of pre-existing and post-insult pathologies. She presented with subarachnoid hemorrhage (SAH) due to a ruptured aneurysm and underwent clipping surgery. Seizures started 3 months post-operatively. MRI revealed cerebral ischemia and hemosiderin deposits in the left temporal lobes, and left hippocampal atrophy was suspected. As anti-seizure medications and vagus nerve stimulation failed to control her seizures, she underwent left temporal lobe resection and placement of a ventriculoperitoneal shunt for the post-operative complication of hydrocephalus. She remains seizure-free to date. Neuropathology revealed a previously undiagnosed focal cortical dysplasia (FCD) type 1a. Brain insult likely had a second hit effect in the late onset of epilepsy in this patient with pre-existing mild MCD, in whom secondary epilepsy can be attributed to the interplay of multiple underlying pathologies.

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