Treatment of Epilepsies Associated with Cerebral Infarction in Childhood

OBJECTIVE: The authors present experience of treatment on the patients who suffered from epileptic seizures with ischemic stroke in their childhood. METHODS: We reviewed the clinical characteristics, neuroimaging findings, and electroencephalographic records of thirteen patients who suffered from seizures with stroke in childhood. Ten patients were improved to be seizure-free or to fall into only rare seizures with appropriate anticonvulsant medication. Three of these patients showed medical intractability in spite of appropriate multi-drug therapy, so they were carefully evaluated to consider the candidate for epilepsy surgery based on our sophisticated presurgical studies. Surgical intervention was performed in these selected 3 cases according to intracranial recordings with subdural grids, who had focal electroencephalographic abnormalities in diffuse cortical lesions. RESULTS: The series included 8 women and 5 men with ages at seizure onset ranging from 3 to 38 years (mean 14.3 years). Cerebral ischemia was caused by various life threatening early insults including febrile convulsion, difficult delivery, viral meningoencephalitis, near drowning, and severe dehydration. Simple partial seizure with or without secondary generalization was most commonly noted. Magnetic resonance image revealed a wide variation in size, shape, and location of the infarcted areas. Major vascular territory and watershed area infarction involving diffuse cerebral cortex was a powerful cause of post-stroke seizure. Excellent clinical result was achieved even in the patients who underwent surgery. CONCLUSION: Control of late onset seizures related to childhood cerebral infarction is not a trivial one, because of its wide, sometimes multilobar territories. However, enthusiastic medical trial as well as comprehensive surgical consideration is essential for better seizure control related to quality of life.

Rebleeding of Cerebral Aneurysm during Three-Dimensional Computerized Tomographic Angiography

The authors report a 59-year-old woman who presented with diffuse subarachnoid hemorrhage and focal intracerebral hemorrhage in the right frontotemporal region with intraventricular hemorrhage after the right middle cerebral artery bifurcation aneurysmal rupture. The aneurysm was rebled during the 3-dimensional computerized tomographic angiography, which was performed 3 hours after initial attack. Although the aneurysm was successfully clipped, the patient died on the second hospital day. We discuss the risk factor of rebleeding of ruptured cerebral aneurysm and whether 3-dimensional computerized tomography angiography is a really safe method of detection of cerebral aneurysm in terms of rebleeding.