Abstract
The aim of this report is to present a case of mesial temporal lobe sclerosis (MTS) causing medically refractory seizures, which was initially disguised as temporal lobe encephalocele secondary to prior otologic surgery. Temporal lobe encephaloceles are characterized by a defect within the middle cranial fossa that results in the abnormal communication of the meninges into the pneumatized skull base. After the temporal lobe encephalocele repair, the patient continued to have seizures and was subsequently diagnosed with mesial temporal lobe sclerosis. Imaging revealed the serial progression of hippocampal atrophy and loss of internal architecture. Differentiation between mesial temporal sclerosis and encephalocele as the underlying epileptic etiology is critical. While repairing encephaloceles is necessary to address other potential sequelae, patients with mesial temporal lobe sclerosis will require additional interventions.
Highlights
Temporal lobe encephaloceles (TLEs) are characterized by a defect within the middle cranial fossa that results in the abnormal communication of meninges into the pneumatized skull base
The aim of this report is to present a case of mesial temporal lobe sclerosis (MTS) causing medically refractory seizures, which was initially disguised as temporal lobe encephalocele secondary to prior otologic surgery
Temporal lobe encephaloceles are characterized by a defect within the middle cranial fossa that results in the abnormal communication of the meninges into the pneumatized skull base
Summary
Temporal lobe encephaloceles (TLEs) are characterized by a defect within the middle cranial fossa that results in the abnormal communication of meninges into the pneumatized skull base. Medically refractory seizures can be seen in up to 2% of patients with TLE [2]. 100% success rates on the resolution of seizures are reported following temporal lobe encephalocele repair [1,2,4]. We report an atypical imaging case of a patient who underwent TLE repair for medically refractory seizures. The patient continued to have seizures following repair and, upon further imaging, was diagnosed with mesial temporal lobe sclerosis (MTS). MTS is due to sclerosis of the hippocampus, which is seen as gliosis and volume loss on imaging [5]. With MTS, electroencephalography (EEG) activity lateralizes to the temporal lobe on the ipsilateral side [6]
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