Faculty Bibliography

We report two cases of ictal vomiting in patients who had left temporal lobe epilepsy. In one patient, vomiting developed when the discharge spread to the right temporal lobe as seen during depth electrode recording. In the second patient, ictal vomiting occurred with a restricted left temporal discharge, but the patient was left-handed and had right-hemisphere language dominance. These cases provide additional evidence of the involvement of the nondominant temporal lobe in ictus emeticus

We reviewed the seizure frequencies of 38 patients with medically refractory epilepsy 6 weeks before (baseline) and 3 weeks after withdrawing their antiepileptic drugs (AEDs) for video-EEG monitoring. Seizure frequency during the first 3 weeks after restarting AEDs was diminished compared with baseline (P < 0.05). We found no correlation between seizure frequency and patient age, specific antiepileptic drugs, number of seizures during the video-EEG monitoring, number of days without AEDs, or partial vs total withdrawal of AEDs. Medication tachyphylaxis, functional tolerance, or long term post-ictal depression of the seizure threshold is hypothesized. The diminished seizure frequency after reinstitution of medications in four of five patients who did not have seizures during their hospitalization suggests that drug tachyphylaxis is a relevant mechanism

Pediatric meningiomas are uncommon. Those presenting in the third ventricle are rare; there are only 15 cases reported in the literature. We report an additional third ventricular meningioma in a 6-year-old boy. The tumor was resected via an anterior transcallosal interfornicial approach. Postoperatively, the patient exhibited a transient episode of mutism. Unlike previous reports, the pathological diagnosis of this lesion was an atypical meningioma. The presentation, management, pathological features, and postoperative course of our case are discussed and compared with previous reports