Abstract Details

Title Intracranial Vasospasm Following Temporal Lobe Epilepsy Surgery Demonsrated on Conventional Angiography

Topic Epilepsy

Presentation(s) P03 - (-)

Poster/Presentation
Number 137

Objective

Background BACKGROUND: Intractable epilepsy can be effectively treated by surgical resection with highest success rates in temporal lobe epilepsy surgery. Intracranial vasospasm, measured indirectly by transcranial doppler (TCD) has been shown to be a complication of temporal lobe epilepsy surgery with female gender and high amount of postoperative blood on CT as significant risk factors.

Design/Methods DESIGN/METHODS: Case Report: A 38 year-old woman with long standing history of pharmacoresistant left temporal lobe epilepsy with concordant electroencephalographic and neuroimaging findings underwent left antero-medial temporal lobe resection. Post-operative course was uneventful. On post-operative day 14, she developed acute new-onset right facial droop and global aphasia. Neuroimaging revealed left middle cerebral artery (MCA) infarct.

Results RESULTS: Conventional angiography was preformed and showed multifocal severe and critical vasospasm in proximal and distal left M1, M2 and M3 segments, proximal inferior division of left MCA. In addition, moderate to severe focal stenosis was present in distal supraclinoid left internal carotid artery and P2 and P3 segments of posterior cerebral artery. Patient received intra-operative angioplasty and milrinone and was placed on milrinone drip for 72 hours. Systolic blood pressure was maintained between 140-160 mmHg with intravenous fluids and pressors. Subsequent follow up in 2-3 days with repeat CT Angiogram showed improvement in the vasospasm, TCDs also normalized with some clinical improvement.

Conclusions CONCLUSIONS: Intracranial vasospasm is well demonstrated by TCDs postoperatively in asymptomatic patients as well as patients with transient and persistant neurological symptoms undergoing temporal lobe epilepsy surgery. In our case we directly demonstrate via conventional angiography that intracranial vasospasm occur post-temporal lobectomy and can lead to focal cerebral ischemia. Combination of angioplasty and intense medical therapy can be an effective treatment strategy in symptomatic vasospasm.

Authors/Disclosures
Reena M. Nanjireddy, MD (UC Davis) PRESENTER	No disclosure on file
Sandra Narayanan, MD, FAAN	Dr. Narayanan has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Narayanan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for MicroVention.
	No disclosure on file
Jeffrey A. Loeb, MD, PhD (University of Illinois At Chicago)	Dr. Loeb has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Sturge Weber Foundation. Dr. Loeb has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for various Law firms. The institution of Dr. Loeb has received research support from Patrick Grange Memorial Foundation. Dr. Loeb has received intellectual property interests from a discovery or technology relating to health care.
Maysaa M. Basha, MD, FAAN (Wayne State University, Detroit Medical Center)	Dr. Basha has nothing to disclose.
Aksel Siva, MD (Istanbul University Cerrahpasa School of Medicine)	Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Genzyme. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen - TR. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Ali Raif Pharmaceuticals, Turkiye. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanovel Pharmaceuticals, Turkiye. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abdi Ibrahim Ilac - TR. Dr. Siva has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck Serono . The institution of Dr. Siva has received research support from Turkish MS Society. The institution of Dr. Siva has received research support from The Scientific and Technological Research Council Of Turkey - Health Sciences Research Grants.

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