Transient symptomatic vasospasm following antero-mesial temporal lobectomy for refractory epilepsy

Arterial vasospasm has rarely been reported following temporal lobectomy for intractable epilepsy.

A 31-year-old patient presented with a global aphasia 2 days after a left dominant anteromesial temporal lobectomy for intractable epilepsy. Magnetic resonance imaging on 5th post-operative day revealed severe narrowing of M1 segment of the left middle cerebral artery (MCA) and Transcranial Doppler (TCD) ultrasonography an increased velocity of the MCA that suggested a severe vasospasm. The patient received continuous intravenous hyperhydratation and nimodipine; aphasia improved within 24 h and resolved completely within 6 weeks, associated with velocity reduction on control TCD.

Transient vasospasm is a likely underestimated cause of focal deficit following temporomesial resection that deserves appropriate treatment.