A case of cerebral aneurysm associated with complex partial seizures

Small Unruptured Intracranial Aneurysm (≤5 mm) Associated with Epilepsy: Report of 2 Cases and Literature Review

BACKGROUND

Owing to the continuing improvements in imaging technology, an increasing number of epileptogenic small (≤5 mm) unruptured intracranial aneurysms (sUIAs) are being diagnosed. However, these sUIAs have not been systematically described and reviewed until now.

CASE DESCRIPTION AND LITERATURE REVIEW

We report 2 patients with sUIAs who initially presented with complex partial seizures. Scalp electroencephalography identified the seizure activity as arising from the mesial temporal/frontal areas, but conventional magnetic resonance imaging (MRI) was normal in both patients. The diagnosis of sUIA was achieved by cerebral angiography. One of the patients had idiopathic seizures and sustained a subarachnoid hemorrhage before the final diagnosis of sUIA. Both of the patients were treated by surgical clipping without resection of the adjacent discolored brain tissue, and the seizures were controlled after surgery. Furthermore, we thoroughly reviewed the relevant literature. We analyzed a total of 5 documented cases, including out 2 cases, and described the clinical characteristics, diagnosis, underlying mechanism, treatment, and prognosis of epileptogenic sUIA.

CONCLUSIONS

The seizures caused by sUIAs are most likely related to subclinical hemorrhages. Angiography may be helpful in identifying seizures associated with sUIA in patients with normal conventional MRI findings. For epileptogenic sUIA with normal preoperative MRI, clipping without damaging the surrounding brain tissue may be sufficient to resolve this complex issue.

Temporal lobe seizures from a posterior cerebral artery aneurysm presenting as memory flashbacks

Memory flashbacks are usually attributed to recreational drugs or psychiatric conditions. The differential diagnosis for memory flashbacks is diverse and challenging; moreover, management is influenced by the working diagnosis. We describe the case of a 35-year-old man who presented with memory flashbacks secondary to temporal lobe seizures from an unruptured aneurysm of the posterior cerebral artery. To our knowledge, a case of this nature has not been previously reported. This case demonstrates the need to recognize that, on rare occasions, a complaint of memory flashbacks can be the result of an organic etiology. We also discuss the challenging presentations of temporal lobe seizures, as they can easily be misdiagnosed as a psychiatric condition.

Unruptured aneurysm of the middle cerebral artery presenting with psychomotor seizures: case study and review of the literature

An intracranial aneurysm would be low on the differential diagnosis of a patient presenting with behavioral or emotional changes. Nonetheless, complex partial seizures (CPS) may cause such symptoms and result from an unruptured intracranial aneurysm. Failure to diagnose and treat this condition in a timely manner increases the patient's risk of catastrophic aneurysmal rupture. This report describes a 55-year-old woman who presented following two CPS which began with the perception of a strange smell and culminated in a brief loss of consciousness. She had no history of seizure disorder or recent trauma. Magnetic resonance imaging (MRI) revealed a space-occupying lesion over the right temporal lobe near the amygdala. Magnetic resonance angiography (MRA) confirmed a 1.5-cm right middle cerebral artery aneurysm, with a dome projecting toward the amygdalohippocampal region. Following surgical ablation, the patient's CPS were well controlled. A review of the literature is performed on this unusual etiology and management strategies are discussed.

Unruptured intracranial aneurysm presenting with epiletic seizure

Intracranial aneurysms are frequently present with subarachnoid hemorrhage.Less often they produce suggestive symptoms of cranial nerve dysfunction or intracranial tumor when very large. Their association with epilepsy has rarely been reported; such concurrence may not be a coincidence. When the patient presents with epileptiforme attacks the presence of an intracranial aneurysm is rarely considered. In this paper we report the case of a 45-years-old patient with an unruptured aneurysm of the middle cerebral artery with a 10 years history of epileptic seizure.

Unusual association of intractable temporal lobe seizures and intracranial aneurysms in an adolescent: is it a coincidence?

Intracranial aneurysms in the pediatric age group are rare occurrences. They usually present with subarachnoid hemorrhage or mass effect. Their association with epilepsy has rarely been reported; such concurrence may not be a coincidence. We present a 16-year-old girl with a 5-year history of medically intractable complex partial seizures. Preoperative electrophysiological and neuroimaging studies demonstrated an epileptogenic focus and atrophy in the right mesial temporal lobe, and ipsilateral incidental aneurysm at the carotid artery bifurcation. The patient underwent a complete right anterior temporal lobectomy, followed by clipping of the aneurysm. We concluded that the epilepsy management in association with cerebral aneurysms is controversial, but when surgery is indicated, clipping of the aneurysm and resection of the epileptogenic focus may provide the optimal outcome. The relevant literature is reviewed and the possible mechanisms of production of epilepsy by intracranial aneurysms are discussed.