A surgical solution for a catamenial epilepsy medical therapy-resistant: A presumed case of cerebral endometriosis?

Abstract

The presence of catamenial epilepsy in patients diagnosed with endometriosis is the symptom that would direct towards a suspected cerebral endometriotic localization. However, data research of medical literature supporting this diagnosis shows a small number of studies and the specific research on medline led to the finding of only four case reports. Hence forward, we will report a case of a patient with the surgical diagnosis of ovarian endometriosis, whom had signs of catamenial epilepsy resistant to medical therapy, and with contraindication to hormone therapy because of cerebral ischemic episodes, subjected to laparoscopic bilateral ovarosalpingectomy.

Psychiatric Symptoms in Patients with Cerebral Endometriosis: A Case Report and Literature Review

“…All patients, including the one we described, had neurological symptoms at some point during the course of the disease. Abortions or full-term pregnancies before experiencing symptoms occurred in five out of seven women that were described in literature [ 40 , 41 , 43 , 46 ] but not in our patient. The most commonly reported neurological symptoms were seizures and headaches.…”

“…In three cases as well as in ours, the diagnosis of endometriosis was solely presumptive [ 43 , 44 , 46 ]. In some cases, the presumptive diagnosis was supported by the temporal correlation of neurological symptoms with menstruation and by the fact that the symptomatology was resolved with medical or surgical menopause.…”

“…All the cases collected, including our case, concerned women who showed an onset of neurological or psychiatric symptoms during the childbearing age (20–44 years). All cases found in the literature review were described by specialists in the neurological or gynecological field, including four clinical cases described by neurologists [ 40 , 41 , 42 , 45 ], two provided by gynecologists [ 44 , 46 ], and one by a gynecologist together with a neurologist [ 43 ]. While neurological symptoms dominated the clinical picture in most cases, psychiatric disorders were never reported.…”

“…In one case, there were gadolinium non-enhancing lesions on the brain MRI [ 43 ], and in the other, there were hemosiderin deposits [ 44 ]. Instead, in the last patient with presumed endometriosis, an MRI revealed abnormalities that were considered compatible with hypoxic-ischemic episodes [ 46 ].…”

“…One additional case of a 44-year-old woman with epilepsy related to cerebral endometriosis was recently reported [ 46 ]. Since menarche, the patient had experienced catamenial epileptic seizures, dysmenorrhea, pelvic discomfort, and dyschezia.…”