A 45-year-old woman had complex partial seizures for 25 years with pharmacoresistance for 2 years. EEG showed right temporal epileptiform discharges. MRI revealed atrophy of the right temporal parenchyma (figure, A) herniating toward the pterygomaxillary fossa and the sphenoidal sinus (figure, C). CT demonstrated the bone defect of the sphenoid wing (figure, B) whereas the fusion of both techniques identified this abnormality as an anterobasal temporal encephalocele (figure, D) causing this late-onset epilepsy.1,2
Figure (A) Axial FLAIR, (B) coronal CT, (C) sagittal three-dimensional MR, and (D) fusion between CT and MR showing the right temporal lobe herniating toward the pterygomaxillary fossa and the sphenoidal sinus (arrows)
Fusion of images demonstrated the skull bone defect (arrowheads) and parenchyma in the sphenoidal sinus (arrows).
Encephaloceles can arise from neural tube defect or trauma. Such a congenital temporal encephalocele should be considered in the differential diagnosis of temporal epilepsy and should prompt a surgical workup which may be curative.
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