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Partial seizures with visual disturbance treated by radiotherapy of cavernous hemangioma
1Department of Neurology, Prince Henry Hospital, Sydney, New South Wales, Australia.
Abstract:
A man aged 26 years had been subject to frequent transient episodes of left homonymous hemianopia, initially accompanied by visual hallucinations and left miosis, since the age of 8 years. These partial seizures recurred 3 to 30 times each month in spite of treatment with anticonvulsant medication. The causative lesion, which had escaped detection by cerebral angiography and repeated computed tomographic scanning, was shown by magnetic resonance imaging to be a small cavernous hemangioma in the right occipital lobe. This was treated by a course of fine-beam radiotherapy directed to the lesion. After treatment the partial attacks ceased, although one nocturnal clonic seizure occurred 12 months after radiotherapy and 6 weeks after stopping all anticonvulsant medication.
Insights
A rare brain lesion, cavernous hemangioma, caused frequent visual seizures in a young man. Radiotherapy successfully stopped these partial seizures, offering a new treatment option.
Area of Science:
- Neurology
- Neurosurgery
- Radiotherapy
Background:
- Cavernous hemangiomas are rare vascular malformations in the brain.
- Epilepsy is a common neurological disorder characterized by recurrent seizures.
- Left homonymous hemianopia is a visual field defect affecting the left side of the visual field of both eyes.
Observation:
- A 26-year-old male experienced frequent partial seizures with left homonymous hemianopia, visual hallucinations, and left miosis since age 8.
- These seizures persisted despite anticonvulsant treatment and were initially undetected by angiography and CT scans.
- Magnetic resonance imaging (MRI) revealed a small cavernous hemangioma in the right occipital lobe.
Findings:
- The patient underwent fine-beam radiotherapy targeting the occipital cavernous hemangioma.
- Following radiotherapy, the patient's partial seizures ceased.
- A single nocturnal clonic seizure occurred 12 months post-radiotherapy, coinciding with the cessation of anticonvulsant medication.
Implications:
- Fine-beam radiotherapy can be an effective treatment for epilepsy caused by cavernous hemangiomas.
- MRI is crucial for diagnosing small cavernous hemangiomas missed by other imaging modalities.
- This case highlights the potential for radiotherapy in managing refractory focal epilepsy.