ABSTRACT
Psychiatric symptoms associated with frontal lobe unruptured or ruptured intracranial dermoid cysts are rarely described in the medical literature. The case of a 58-year-old man with a chronic history of anxiety, major depression, and obsessive compulsive disorder who presented with new onset auditory and visual phenomena is described. This case illustrates the need to include an underlying brain tumor in the differential diagnosis when encountering new onset auditory and visual phenomena in patients with chronic mood and/or anxiety disorders.
Subject(s)
Brain Neoplasms/psychology , Depressive Disorder, Major/etiology , Dermoid Cyst/psychology , Hallucinations/etiology , Obsessive-Compulsive Disorder/etiology , Brain Neoplasms/pathology , Brain Neoplasms/surgery , Dermoid Cyst/pathology , Dermoid Cyst/surgery , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Rupture, SpontaneousABSTRACT
PURPOSE: To examine long-term seizure and quality-of-life outcome in a homogeneous group of patients after temporal lobectomy with pathologically proven hippocampal sclerosis (HS). Previous research has had limited follow-up (generally <2 years) and has grouped patients across multiple pathologies. METHODS: Fifty consecutive patients were identified as having had a temporal lobectomy for the treatment of temporal lobe epilepsy at Royal Melbourne Hospital with pathologically proven HS and >or=2 years' follow-up. All patients were sent a postal survey concerning seizure activity, quality of life (QOLIE-89), and antiepileptic drug (AED) use. The mean follow-up was 5.8 years (range, 2-9.2). RESULTS: The rate of complete postoperative seizure freedom was 82% at 12 months, 76% at 24 months, and 64% at 63 months (no further seizure recurrences observed after this time). A class I seizure outcome was achieved by 83.3% of patients. Patients with better seizure outcome had significantly better quality of life (Kendall's tau =-234, p < 0.01). Seizure recurrence was associated with a reduction in AED intake or absorption in five (29%) of 17 cases, including three of the five patients with a first seizure recurrence after 24 months after surgery. CONCLUSIONS: Temporal lobectomy provides continued long-term seizure control in the majority of patients with HS. However, patients remain at risk of seizure recurrence >or=2 years after surgery. Long-term quality of life is dependent on seizure outcome.
