An unusual presentation of an epidermoid brain tumour: a tale of two specialties

Abstract

A 33-year-old right-handed lady was referred to the psychiatry and neurology services by her general practitioner. Previously, she was under psychiatric care for bipolar affective disorder. Recently, her mood had deteriorated prompting the re-referral to the psychiatrists. In addition she had strange attacks. These strange attacks seemed to her like 'sensory overload' or that the 'brain just stops'. Other sensations throughout the attacks included feeling like she is in a 'fish bowl' and surrounding sights and sounds were distorted. She could not speak. After the attack she was hot and flustered, suffered memory loss and was tearful. Both the psychiatrist and the neurologist considered the possibility of these attacks being psychiatric in aetiology. However, the alternative possibility of a coexistence to epilepsy and depression was investigated and MRI demonstrated an epidermoid tumour with the supratentorial portion displacing the left temporal lobe.

Surgical Management of Temporal Lobe Epilepsy Secondary to Epidermoid Cysts: A Case Report With Review of the Literature

“…Data are scarce, and there is no guideline on which surgical strategy to opt for. However, previous case reports have shown seizure-free after radical surgical management of these lesions (Table 1) [1,[10][11][12][13][14][15]. Gross total resection should be attempted whenever possible.…”

“…In a patient with a CP angle epidermoid cyst extending to the medial aspect of the left temporal lobe, they found conservative treatment alone to have little impact. Their patient became seizure-free after cytoreductive surgery [ 15 ]. Hanft et al [ 10 ] described awake right temporal craniotomy for a right superior temporal lobe epidermoid cyst achieving seizure freedom at five-year follow-up.…”