Unexpected Aphasia following Right Temporal Lobectomy as Treatment of Recurrent Super-Refractory Status Epilepticus

Abstract

Background: Super-refractory status epilepticus (SRSE) is a critical neurological condition with a high mortality rate. There are only limited data to direct the treatment in SRSE, and surgery has been reported to successfully stop SRSE. We present a case of recurrent SRSE treated with urgent right temporal lobectomy in a right-handed woman which potentially saved her life but resulted in crossed sensory aphasia.

Case description: A 61-year-old woman with a recent episode of prolonged focal SRSE due to right frontotemporal meningioma and hyperkalemia was admitted for recurrence of seizures that evolved to SRSE despite aggressive treatment with multiple fosphenytoin antiepileptic drugs (AEDs) and anesthetics. The patient underwent a right temporal lobectomy to remove the encephalomalacic and gliotic tissue around the meningioma that had been resected during a previous admission. Postoperatively the patient had a protracted course with modest improvement after stepwise reduction in her AEDs; however, her recovery unveiled a severe crossed aphasia.

Conclusion: Resective surgery is an effective treatment option in the treatment of SRSE, although the recovery period can be protracted. Crossed aphasia after right temporal lobectomy should be considered in patients where it is not possible to complete a presurgical evaluation of higher cortical functions.

Keywords: Crossed aphasia; Super-refractory status epilepticus; Temporal lobectomy.

Fig. 1.

Brain magnetic resonance imaging (MRI) of a patient with super-refractory status epilepticus (SRSE) treated with surgical resections. a T1-weighted MRI with contrast image showing right frontotemporal meningioma with mild right to left midline shift. b Postoperative T1-weighted MRI with contrast image after meningioma resection during the first SRSE. c Fluid-attenuated inversion recovery image showing encephalomalacia and gliosis along the right superior temporal gyrus noted during recurrent SRSE, 2 months after meningioma resection. d Postoperative T1-weighted MRI with contrast image after temporal lobectomy and hippocampectomy.