陳旧性側頭葉内出血に伴う内側側頭葉てんかん—形態学的にDual Pathologyを認めなかった2例

Two Cases of Mesial Temporal Lobe Epilepsy Associated with Old Intracerebral Hemorrhage in the Lateral Temporal Lobe without “Dual Pathology”

I．はじめに

　血管奇形であれ外傷であれ側頭葉内の出血が難治性側頭葉てんかんの原囚となることはよく知られている^2,5,15）が，この病態について詳細に記載した報告はない．われわれは陳旧性の側頭葉内出血に関連して難治性側頭葉てんかんを起こすようになった2例において，慢性硬膜下電極記録と病理組織学的検査によりその病態を検討したので報告する．

Two cases of intractable temporal lobe epilepsy associated with old intracerebral hemorrhage in thelateral temporal lobe were reported. Although preoperative magnetic resonance imaging (MRI) failed toreveal hippocampal atrophy with T2 hyperintensity, electrocorticographic (ECoG) recording with chronicinvasive subdural electrodes indicated the mesial temporal lobe to be an ictal onset zone. After anteriortemporal lobectomy involving the lesion and hippocampectomy, the patients became seizure-free.

Hippocampal sclerosis, namely “dual pathology”, was not noted on histological examination.

Careful ECoG recording with chronic subdural electrodes is mandatory even when the preoperative MRIdoes not demonstrate the radiological hippocampal sclerosis.