title: Remote infarct of the temporal lobe with coexistent hippocampal sclerosis in mesial temporal lobe epilepsy.
abstract: In patients undergoing surgery for temporal lobe epilepsy, hippocampal sclerosis remains the most commonly observed pathology. In addition to hippocampal sclerosis, 5% to 30% of these resections on magnetic resonance imaging contain a second independently epileptogenic lesion, commonly referred to as dual pathology. A second etiology of seizure activity, as seen in dual pathology, may serve as an important cause of treatment failure in striving for post-operative seizure control. Dual pathology, consisting of hippocampal sclerosis and a remote infarct of the adjacent cortex, has been rarely reported. Cases of pathologically confirmed hippocampal sclerosis diagnosed between January 2000 and December 2012 (n = 349) were reviewed, and 7 cases of coexistent infarct (2%) formed the study group. Seven individuals (mean age, 29years; range, 5-47 years) with a mean epilepsy duration of 12.5years (3.3-25 years) and a mean pre-surgery frequency of 15 seizures per week (range, 0.5-56 seizures/week) were followed up postoperatively for a mean duration of 64months (range, 3-137 months). Pathologically, the most common form of hippocampal sclerosis observed was International League against Epilepsy type Ib or severe variant (n = 4). Four of the six individuals with post-surgery follow-up were seizure free at last encounter. The reported incidence of dual pathology, including hippocampal sclerosis and remote infarct, is low (2% in the present study) but may indicate a slightly increased risk of developing hippocampal sclerosis in the setting of a remote infarct. Surgical intervention for such cases anecdotally appears effective in achieving seizure control.
authors.affiliation: Cleveland Clinic Department of Anatomic Pathology and Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195.
authors.forename: Jordan M
authors.initials: JM
authors.lastname: Gales
authors.affiliation: Cleveland Clinic Department of Anatomic Pathology and Cleveland Clinic Lerner College of Medicine, Cleveland, OH 44195. Electronic address: praysor@ccf.org.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Prayson
mesh_terms: D000293:Adolescent; D000328:Adult; D002544:Cerebral Infarction / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D004833:Epilepsy, Temporal Lobe / Q000473:pathology*; D005260:Female; D006624:Hippocampus / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012598:Sclerosis / Q000473:pathology; D013702:Temporal Lobe / Q000473:pathology*; D055815:Young Adult
keywords: Dual pathology; Epilepsy; Focal cortical dysplasia; Hippocampal sclerosis; Remote infarct