Folia Psychiatrica et Neurologica Japonica, Vol. 32, No. 3, 1978
Computerized Axial Tomography in Temporal Lobe Epilepsy Kunimitsu Yamamoto, M.D., Tadahiro Mihara, M.D., Eiki Kobayashi, M.D., Kenji Yamashita, M.D. and Tetsuhiko Asakura, M.D. Department of Neurosurgery, University of Kagoshima, Faculty of Medicine, Kagoshima
In the past, epilepsy had been diagnosed on the basis of a patient's history, neurological findings, electroencephalography (EEG ) and conventional neuroradiology. However, computerized axial tomography (CT) has been introduced to neuroradiological examinations and used in the diagnosis of epilepsy as often as EEG. In this study, the authors report that computerized axial toniography is of importance for the etiologic diagnosis of tcmporal lobe epilepsy. Computerized axial tomography was performed on 40 patients with temporal lobe epilepsy, from Sept. 1976 to Oct. 1977. All CT scans were performed with 16OX 160 matrix EM1 1000. Sex ratio was 25 males and 15 females. The average age was 24.5 years, ranging from three to 68. The CT was normal in 17 patients (42.5%) and abnormal in 23 patients (57.5%): 9 patients (39.1%) had diffuse or focal cortical atrophy (Fig. 1); 8 patients (34.8%) showed localized low density in the temporal lobe (Fig. 2); 5 patients ( 2 1.7%) had symmetrical or asymmetrical ventricular dilatation; 1 patient (4.476) showed multiple calcification with ventricular dilatation and middle cranial fossa asymmetry (Fig. 3 ) . On correlation with CT findings to clinical seizure, 26.6% in the group with cor-
Received for publication Apr. 30, 1978.
tical atrophy showed automatism, while 21.7% in the group with localized low density of the temporal lobe had impaired consciousness. In six cases out of 17 patients, the differences in contrast enhancement in the bilateral amygdalo-hippocampal region were studied. Five out of six patients showed much greater enhancement, corresponding to the the side of spike discharge in EEG. Gastaut' reported that cerebral lesions were found on CT in 63% of partial epilepsy cases and concluded that either CT was not reliable in demonstrating temporal lobe pathology, or else some diffuse lesions caused the partial attacks because temporolimbic structures have a low convulsive threshold. In this series, however, the proportion of cerebral lesions discerned by CT was 57.5% less than the main findings of localized low density area in the temporal lobe and cortical atrophy. Despite difficulties in stating a direct cause-and-effect relationship between CT findings and epileptic symptoms, a more precise diagnosis of epilepsy can be expected from CT scan. REFERENCES 1
Gastaut, H.: Computerized Transverse Axial Tomography in Epilepsy, Epilepsia, 17(3): 325-336, 1976.
402
K. Yamamoto
et
al.
Fig. 1 : Diffuse cortical atrophy. 25 years old man. His clinical seizure was gestural automatism. EEG showed spike discharge at the left anterior temporal. CT findings were asymmetrical moderately ventricular dilatation and cortical sulci widening.
CT in Temporal Lobe Epilepsy
Fig. 2: Localized low density in left temporal lobe. 23 years old man. His clinical seizure was impaired consciousness. EEG showqd moderate voltage sporadic theta wave focus at left posterior temporal. CT finding was localized low density in left temporal bbe. Contrast enhancement was not seen,
403
404
K. Yamamoto et al.
Fig. 3 : Multiple calcifications with ventricular dilatation and middle cranial fossa asymmetry. 22 years old woman. Her clinical seizure was verbal automatism. EEG showed spike discharge at right anterior temporal. CT findings were multiple calcification with ventricural dilatation and middle cranial fossa asymmetry.
Computerized Axial Tomography in Temporal Lobe Epilepsy Kunimitsu Yamamoto, M.D., Tadahiro Mihara, M.D., Eiki Kobayashi, M.D., Kenji Yamashita, M.D. and Tetsuhiko Asakura, M.D. Department of Neurosurgery, University of Kagoshima, Faculty of Medicine, Kagoshima
In the past, epilepsy had been diagnosed on the basis of a patient's history, neurological findings, electroencephalography (EEG ) and conventional neuroradiology. However, computerized axial tomography (CT) has been introduced to neuroradiological examinations and used in the diagnosis of epilepsy as often as EEG. In this study, the authors report that computerized axial toniography is of importance for the etiologic diagnosis of tcmporal lobe epilepsy. Computerized axial tomography was performed on 40 patients with temporal lobe epilepsy, from Sept. 1976 to Oct. 1977. All CT scans were performed with 16OX 160 matrix EM1 1000. Sex ratio was 25 males and 15 females. The average age was 24.5 years, ranging from three to 68. The CT was normal in 17 patients (42.5%) and abnormal in 23 patients (57.5%): 9 patients (39.1%) had diffuse or focal cortical atrophy (Fig. 1); 8 patients (34.8%) showed localized low density in the temporal lobe (Fig. 2); 5 patients ( 2 1.7%) had symmetrical or asymmetrical ventricular dilatation; 1 patient (4.476) showed multiple calcification with ventricular dilatation and middle cranial fossa asymmetry (Fig. 3 ) . On correlation with CT findings to clinical seizure, 26.6% in the group with cor-
Received for publication Apr. 30, 1978.
tical atrophy showed automatism, while 21.7% in the group with localized low density of the temporal lobe had impaired consciousness. In six cases out of 17 patients, the differences in contrast enhancement in the bilateral amygdalo-hippocampal region were studied. Five out of six patients showed much greater enhancement, corresponding to the the side of spike discharge in EEG. Gastaut' reported that cerebral lesions were found on CT in 63% of partial epilepsy cases and concluded that either CT was not reliable in demonstrating temporal lobe pathology, or else some diffuse lesions caused the partial attacks because temporolimbic structures have a low convulsive threshold. In this series, however, the proportion of cerebral lesions discerned by CT was 57.5% less than the main findings of localized low density area in the temporal lobe and cortical atrophy. Despite difficulties in stating a direct cause-and-effect relationship between CT findings and epileptic symptoms, a more precise diagnosis of epilepsy can be expected from CT scan. REFERENCES 1
Gastaut, H.: Computerized Transverse Axial Tomography in Epilepsy, Epilepsia, 17(3): 325-336, 1976.
402
K. Yamamoto
et
al.
Fig. 1 : Diffuse cortical atrophy. 25 years old man. His clinical seizure was gestural automatism. EEG showed spike discharge at the left anterior temporal. CT findings were asymmetrical moderately ventricular dilatation and cortical sulci widening.
CT in Temporal Lobe Epilepsy
Fig. 2: Localized low density in left temporal lobe. 23 years old man. His clinical seizure was impaired consciousness. EEG showqd moderate voltage sporadic theta wave focus at left posterior temporal. CT finding was localized low density in left temporal bbe. Contrast enhancement was not seen,
403
404
K. Yamamoto et al.
Fig. 3 : Multiple calcifications with ventricular dilatation and middle cranial fossa asymmetry. 22 years old woman. Her clinical seizure was verbal automatism. EEG showed spike discharge at right anterior temporal. CT findings were multiple calcification with ventricural dilatation and middle cranial fossa asymmetry.
