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Grand Rounds

Epilepsy and cognitive deterioration as postoperative complications of the arachnoid cyst fenestration: Case report

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Pages 1599-1609 | Received 17 Jun 2020, Accepted 12 Oct 2020, Published online: 26 Oct 2020
 

Abstract

Objective: With the aim of contributing to the discussion on treatment of patients with arachnoid cysts (AC) and their neuropsychological functioning, we present the case of a patient who has undergone surgery of AC located in the left Sylvian fissure. Case description: The patient had no cognitive deficits and no seizures before the cyst’s fenestration. After the procedure, however, occurrences of seizures have been observed. Along with the concomitant epileptic seizures, aphasia and serious memory problems also developed. The initial pharmacological treatment of the seizures brought about unsatisfactory results. The treatment was therefore modified a number of times and ultimately, seizures were brought under control to some extent. Despite the varied efforts at neuropsychological rehabilitation, cognitive impairment was still persistent up to a year after the surgery. Conclusions: 1) While referring patients with AC for surgery, one should always consider both the positive outcomes and the unintended and deleterious consequences. A cyst fenestration could in some cases lead to epilepsy and cause neuropsychological symptoms such as anomic aphasia and cognitive deterioration with memory function impairment. 2) Neurological patients, especially the ones qualified for surgery, should always undergo neuropsychological examination. The lack of data from presurgical neuropsychological examination may impact further treatment of neurosurgical patients.

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Disclosure statement

The Authors declare that there is no conflict of interest.

Notes

1 The Tetron scale is normalized so that the population mean is 10 and the standard deviation is 4. The scale has 21 units (0 to 20 points). It covers the range from -2.5 to +2.5 of the standard deviation of the results in the normal distribution.

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