Traumatic Medial Temporal Lobe Epilepsy Associated with a Subcortical Lesion in the Internal Capsule - A Case Report

Abstract

Although there is no universally accepted definition, traumatic medial temporal lobe epilepsy (traumatic MTLE) can be generally defined as a type of post-traumatic epilepsy with medial temporal epileptogenicity. Previous studies have demonstrated that patients with traumatic MTLE frequently have hippocampal sclerosis (HS) coexisting with traumatic neocortical lesions. We report a 39-year-old MTLE patient with a subcortical lesion in the internal capsule, suspected to be caused by mild diffuse axonal injury. The results of presurgical examinations and intraoperative electrocorticograms were consistent with a diagnosis of MTLE. Therefore, an anterior temporal lobectomy with hippocampectomy was performed. A 3D short tau inversion recovery 3-Tesla MRI scan clearly depicted possibly Wallerian degeneration in the temporal stem, which was continuous with the subcortical lesion. We speculate that Wallerian degeneration in the temporal stem could potentially involve the hippocampus, eventually leading to HS.