Turkish Neurosurgery 2005 , Vol 15 , Num 2
Late Onset Continuous Verbal Perseveration After Glial Tumor Surgery: A Rare Ictal Phenomenon
Feridun ACAR1, Göksemin ACAR2, Serhat ERBAYRAKTAR3, Süleyman MEN4, D. Ümit ACAR3
1Department of Neurosurgery, Gülhane Military Medical Academy, Ankara, Turkey
2Department of Neurology, School of Medicine, Pamukkale University, Denizli, Turkey
3Department of Neurosurgery, School of Medicine, Dokuz Eylül University, İzmir, Turkey
4Department of Radiodiagnostics, School of Medicine, Dokuz Eylül University, İzmir, Turkey
OBJECTIVE: Perseveration is a rarely observed symptom during the course of neurosurgical diseases. As all perseverations are not uniform, determination of the corresponding brain regions is of great importance prior to deciding whether it represents a destructive or an irritative process.

CLINICAL PRESENTATION: A right-handed 33-year-old patient with a subtotally excised left temporoparietal low-grade astrocytoma was readmitted 9 months later with a complaint of new-onset continuous verbal perseveration which is primarily a sign of a non-dominant hemisphere abnormality. Repeat magnetic resonance imaging showed no change in the residual tumor size or in the edema. No new tumor focus was detected.

DISCUSSION: The patient's electroencephalogram indicated a contralateral right-sided epileptic focus. The carbamezapine dosage was increased and the perseverations subsided rapidly.

CONCLUSION: The late-onset ictal perseveration did not imply tumor progression and was triggered by the focus on the contralateral hemisphere, most probably caused by radiotherapy. Keywords : Glial tumor, ictal, radiotherapy, surgery, verbal perseveration

Corresponding author : Feridun Acar, feridunacar@yahoo.com