Intracerebral schwannoma presenting as classic temporal lobe epilepsy

Abstract

Schwannomas of the brain parenchyma are extremely rare, occurring mostly in children and young adults. Fewer than 50 cases have been reported in the English-language literature. Isolated temporal lobe epilepsy is a rare presentation of intracerebral schwannomas, with only 2 reported cases. The authors present the case of a 51-year-old woman with a 4-year history of medication-refractory seizures, which were localized on electroencephalography to the right temporal lobe. Magnetic resonance imaging identified a mildly space-occupying, T2 hyperintense, and inhomogeneously enhancing mass in her left mesial temporal lobe. Histological, immunohistochemical, and electron microscopy examinations of the surgical specimen established a diagnosis of intracerebral schwannoma. Accurate diagnosis of intracerebral schwannomas is essential, particularly in younger patients, given the lesions' nature, amenity to resection, favorable long-term prognosis, and broad radiological differential. The etiology of these lesions remains unknown, and multiple proposed theories are reviewed.