Observations on so‐called brain stones or cerebral calculi

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Abstract
Four cases of brain stones associated with long-standing epilepsy are presented. In the first case, roentgenogram of the skull revealed multiple calculi scattered in both cerebral hemispheres. In the remaining 3 patients, the radiograms showed large solitary and sharply defined calcified masses in 1 or other temporal lobe. In case 1, the radiologic features were in keeping with the assumption of healed tuberculomato. The history and location of the stone removed in case 2 pointed to the diagnosis of calcified otogenic brain abscess. Although not proved by surgery, the diagnosis of calcified subcortical hematoma in case 3 was suggested by the history of trauma and the X-ray findings. In the last case, the cause remains obscure. The actual incidence of calcification or bone formation in the above lesions is usually very low, as the diagnosis is usually made before calcification may take place. The electroencephalogram was most helpful by demonstrating that the irritative epileptogenic focus corresponded in location to the calcified masses in the temporal lobe, as revealed by the roentgenogram. In the patients in cases 1 and 2, the calculi and adjacent damaged brain tissue were removed during surgery, resulting in maintained inter ruption of the long courses of epilepsy. The excellent long-term result obtained in the first patient, in whom only 1 of the 7 calculi was removed, shows that the temporal lobe was the only area in which epileptic activity was provoked. Whereas many years must elapse before definite conclusions may be reached, it appears that surgical removal of cerebral calculi and adjacent softened brain tissue from relatively silent areas offers hope for selected epileptic patients whose attacks are not controlled by anticonvulsive medication.

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