{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T13:10:01Z","timestamp":1789132201595,"version":"build-2803163510"},"reference-count":46,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T00:00:00Z","timestamp":1789084800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background: Cerebral endometriosis is an exceptionally rare manifestation of extrapelvic endometriosis and remains a diagnostic challenge because its clinical and imaging features may mimic more common neurological, inflammatory, vascular, or neoplastic disorders. Catamenial neurological symptoms may provide an important diagnostic clue, but histological confirmation is rarely available. Case presentation: We report the case of a 48-year-old woman with epilepsy beginning at 41 years of age, associated with short-term memory loss and a catamenial pattern of seizures. She had no typical symptoms of pelvic endometriosis, including dysmenorrhea, dyspareunia, or cyclic pelvic pain. Neuropsychological test for memory had normal scores. Brain magnetic resonance imaging (MRI) revealed a right hippocampal lesion with T2\/FLAIR hyperintensity and later pseudonodular contrast enhancement, raising suspicion of focal cortical dysplasia, infection, tumor infiltration, or a hippocampal tumor. Magnetic resonance spectroscopy (MRS) was inconclusive and did not provide clear support for tumor-like infiltration. Because of the temporal association between symptoms and menstruation, cerebral endometriosis was considered. The patient received hormonal therapy with progestins, including desogestrel and dienogest, after which antiepileptic therapy was discontinued. Neurological symptoms resolved completely. Follow-up MRI demonstrated marked regression or disappearance of the previously described right hippocampal hyperintense lesion, with preserved bilateral hippocampal morphology. Conclusions: This case highlights the importance of considering cerebral endometriosis in women of reproductive or perimenopausal age presenting with catamenial epilepsy and unexplained intracranial lesions, even in the absence of pelvic endometriosis symptoms. Recognition of menstrual cyclicity, careful neuroimaging follow-up, and multidisciplinary evaluation may support diagnosis and guide individualized treatment. The favorable clinical and radiological response to progestin therapy in this case adds to the limited evidence regarding conservative management of presumed cerebral endometriosis. Cerebral endometriosis is a very rare condition, and only eight case reports were found in the literature.<\/jats:p>","DOI":"10.3390\/jcm15187062","type":"journal-article","created":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T12:24:33Z","timestamp":1789129473000},"page":"7062","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Presumed Hippocampal Endometriosis Presenting as Catamenial Epilepsy: Diagnostic Challenges, MRI Follow-Up, and Comparative Review of Reported Cerebral Endometriosis Case"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7082-8749","authenticated-orcid":false,"given":"Mihaela-Camelia","family":"T\u00eernovanu","sequence":"first","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Ia\u0219i, 700115 Ia\u0219i, Romania"},{"name":"Cuza Vod\u0103 Women\u2019s Clinical Hospital Ia\u0219i, 700038 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u0218tefan-Drago\u0219","family":"T\u00eernovanu","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Ia\u0219i, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7859-840X","authenticated-orcid":false,"given":"Elena","family":"Cojocaru","sequence":"additional","affiliation":[{"name":"Grigore T. 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Popa University of Medicine and Pharmacy Ia\u0219i, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7386-0859","authenticated-orcid":false,"given":"Roxana-Ana","family":"Covali","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Ia\u0219i, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1154-7145","authenticated-orcid":false,"given":"Awad","family":"Dmour","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Ia\u0219i, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5637-2095","authenticated-orcid":false,"given":"Norin","family":"Forna","sequence":"additional","affiliation":[{"name":"Grigore T. Popa University of Medicine and Pharmacy Ia\u0219i, 700115 Ia\u0219i, Romania"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"resources","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Paul-Dan","family":"S\u00eerbu","sequence":"additional","affiliation":[{"name":"Grigore T. 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Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/S0140-6736(21)00389-5","article-title":"Endometriosis is a chronic systemic disease: Clinical challenges and novel innovations","volume":"397","author":"Taylor","year":"2021","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/1746-1596-8-194","article-title":"Extrapelvic endometriosis: A rare entity or an underdiagnosed condition?","volume":"8","author":"Machairiotis","year":"2013","journal-title":"Diagn. Pathol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1002\/ca.22617","article-title":"Neural involvement in endometriosis: Review of anatomic distribution and mechanisms","volume":"28","author":"Capek","year":"2015","journal-title":"Clin. Anat."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1111\/j.1528-1157.1997.tb01197.x","article-title":"Three patterns of catamenial epilepsy","volume":"38","author":"Herzog","year":"1997","journal-title":"Epilepsia"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1016\/j.seizure.2015.02.024","article-title":"Catamenial epilepsy: Update on prevalence, pathophysiology and treatment from the findings of the NIH Progesterone Treatment Trial","volume":"28","author":"Herzog","year":"2015","journal-title":"Seizure"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e194","DOI":"10.1111\/epi.17718","article-title":"Catamenial epilepsy occurrence and patterns in a mixed population of women with epilepsy","volume":"64","author":"Voinescu","year":"2023","journal-title":"Epilepsia"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1016\/j.yhbeh.2012.04.016","article-title":"Neuroendocrine aspects of catamenial epilepsy","volume":"63","author":"Reddy","year":"2013","journal-title":"Horm. Behav."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1148\/radiol.2241010361","article-title":"The shading sign","volume":"224","author":"Glastonbury","year":"2002","journal-title":"Radiology"},{"key":"ref_10","first-page":"299","article-title":"Head to toe: Expand your diagnosis on routine imaging to include endometriosis","volume":"51","author":"Carnelli","year":"2026","journal-title":"Abdom. Radiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"223","DOI":"10.5653\/cerm.2023.06128","article-title":"Dienogest in endometriosis treatment: A narrative literature review","volume":"50","author":"Lee","year":"2023","journal-title":"Clin. Exp. Reprod. Med."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1016\/S0014-2999(99)00765-7","article-title":"Dienogest, a synthetic steroid, suppresses both embryonic and tumor-cell-induced angiogenesis","volume":"386","author":"Nakamura","year":"1999","journal-title":"Eur. J. Pharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"644","DOI":"10.3109\/09513590.2014.911279","article-title":"Dienogest reduces proliferation, aromatase expression and angiogenesis, and increases apoptosis in human endometriosis","volume":"30","author":"Miyashita","year":"2014","journal-title":"Gynecol. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Piriyev, E., Schiermeier, S., and R\u00f6mer, T. (2025). Hormonal treatment of endometriosis: A narrative review. Pharmaceuticals, 18.","DOI":"10.3390\/ph18040588"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"609","DOI":"10.3171\/jns.1987.66.4.0609","article-title":"Cerebral endometriosis. Case report","volume":"66","author":"Thibodeau","year":"1987","journal-title":"J. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2708","DOI":"10.1212\/WNL.43.12.2708","article-title":"A case of cerebral endometriosis causing catamenial epilepsy","volume":"43","author":"Ichida","year":"1993","journal-title":"Neurology"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.2214\/ajr.182.6.1821543","article-title":"Cerebellar endometriosis","volume":"182","author":"Sarma","year":"2004","journal-title":"Am. J. Roentgenol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.jmig.2010.09.002","article-title":"Resolution of catamenial epilepsy after goserelin therapy and oophorectomy: Case report of presumed cerebral endometriosis","volume":"18","author":"Vilos","year":"2011","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1080\/09513590.2018.1463362","article-title":"Complete remission of cerebral endometriosis with dienogest: A case report","volume":"34","author":"Maniglio","year":"2018","journal-title":"Gynecol. Endocrinol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1055\/s-0040-1701622","article-title":"Case report of cerebellar endometriosis","volume":"81","author":"Meggyesy","year":"2020","journal-title":"J. Neurol. Surg. A Cent. Eur. Neurosurg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1177\/2284026520966504","article-title":"A surgical solution for a catamenial epilepsy medical therapy-resistant: A presumed case of cerebral endometriosis?","volume":"13","author":"Antonio","year":"2021","journal-title":"J. Endometr. Pelvic Pain Disord."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Elefante, C., Brancati, G.E., Oragvelidze, E., Lattanzi, L., Maremmani, I., and Perugi, G. (2022). Psychiatric symptoms in patients with cerebral endometriosis: A case report and literature review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11237212"},{"key":"ref_23","first-page":"569","article-title":"Abdominal wall endometrioma mimicking an incarcerated hernia: A case report","volume":"5","author":"Simoglou","year":"2012","journal-title":"Int. J. Gen. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1080\/13697137.2019.1578743","article-title":"Diagnosis of endometriosis in the 21st century","volume":"22","author":"Kiesel","year":"2019","journal-title":"Climacteric"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Agarwal, S.K., Chapron, C., Giudice, L.C., Laufer, M.R., Leyland, N., Missmer, S.A., Singh, S.S., and Taylor, H.S. (2019). Clinical diagnosis of endometriosis: A call to action. Am. J. Obstet. Gynecol., 220.","DOI":"10.1016\/j.ajog.2018.12.039"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s13669-025-00433-1","article-title":"Neurologic manifestations of endometriosis: A review of preclinical and clinical evidence","volume":"14","author":"Prakash","year":"2025","journal-title":"Curr. Obstet. Gynecol. Rep."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1616","DOI":"10.1038\/s42003-025-08952-6","article-title":"A cross-sectional analysis of brain structure, pain behaviors, and mental health in persons with surgically confirmed endometriosis","volume":"8","author":"Jotwani","year":"2025","journal-title":"Commun. Biol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1212\/WNL.45.5.1000","article-title":"Recurrent subarachnoid hemorrhage due to endometriosis","volume":"45","author":"Duke","year":"1995","journal-title":"Neurology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1007\/s00586-013-2988-x","article-title":"Low back pain tied to spinal endometriosis","volume":"23","author":"Dongxu","year":"2014","journal-title":"Eur. Spine J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jad.2020.03.047","article-title":"Risk of bipolar disorder in patients with endometriosis: A nationwide population-based cohort study","volume":"270","author":"Chen","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Gao, M., Koupil, I., Sj\u00f6qvist, H., Karlsson, H., Lalitkumar, S., Dalman, C., and Kosidou, K. (2020). Psychiatric comorbidity among women with endometriosis: Nationwide cohort study in Sweden. Am. J. Obstet. Gynecol., 223.","DOI":"10.1016\/j.ajog.2020.02.033"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1186\/s12974-023-02713-0","article-title":"Endometriosis leads to central nervous system-wide glial activation in a mouse model of endometriosis","volume":"20","author":"Bashir","year":"2023","journal-title":"J. Neuroinflamm."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"103758","DOI":"10.1016\/j.compbiomed.2020.103758","article-title":"Brain tumor segmentation and grading of lower-grade glioma using deep learning in MRI images","volume":"121","author":"Naser","year":"2020","journal-title":"Comput. Biol. Med."},{"key":"ref_34","unstructured":"Szabo, M., Buck, L., Steel, A., Becker, C.M., and Vincent, K. (2021, January 6\u201310). Volumetric changes in the brains of women with endometriosis-associated pain are dynamic. Presented at the World Endometriosis Congress, Virtual."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Khalil, H.A., Darwish, S., Ibrahim, Y.M., and Hassan, O.F. (2020). 3D-MRI brain tumor detection model using modified version of level set segmentation based on dragonfly algorithm. Symmetry, 12.","DOI":"10.3390\/sym12081256"},{"key":"ref_36","unstructured":"Gaillard, F., Sattar, A., Jones, J., Khana, F., Sharma, R., Mahmud, A., Agazzi, G., Yap, J., Saber, M., and Sciacca, F. (2026, March 10). MR Spectroscopy. Radiopaedia.org. Available online: https:\/\/radiopaedia.org\/articles\/mr-spectroscopy-1\/revisions?lang=us."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1016\/j.ejogrb.2014.05.028","article-title":"Could statins constitute a novel treatment for endometriosis? Systematic review of the literature","volume":"179","author":"Gibran","year":"2014","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1055\/a-2760-4867","article-title":"Diagnosis and therapy of endometriosis. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015\/045, April 2025)","volume":"86","author":"Burghaus","year":"2026","journal-title":"Geburtshilfe Frauenheilkd."},{"key":"ref_39","first-page":"85","article-title":"Germany endometriosis pattern changes; prevalence and therapy over 2010 and 2019 years: A retrospective cross-sectional study","volume":"16","author":"Drewes","year":"2022","journal-title":"Int. J. Fertil. Steril."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"393","DOI":"10.2147\/IJWH.S77202","article-title":"Safety and tolerability of dienogest in endometriosis: Pooled analysis from the European clinical study program","volume":"7","author":"Strowitzki","year":"2015","journal-title":"Int. J. Womens Health"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"895","DOI":"10.1080\/03007995.2020.1744120","article-title":"Use of dienogest in endometriosis: A narrative literature review and expert commentary","volume":"36","author":"Murji","year":"2020","journal-title":"Curr. Med. Res. Opin."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Tang, M., Yang, W., and Zhang, H. (2023). Comparison of the efficacy of dienogest and GnRH-a after endometriosis surgery. BMC Womens Health, 23.","DOI":"10.1186\/s12905-022-02118-w"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Li, R.R., Xi, Q., Tao, L., Sheng, W., Zhao, C.C., and Wu, Y.J. (2024). A systematic review and Bayesian analysis of the adverse effects of dienogest. BMC Pharmacol. Toxicol., 25.","DOI":"10.1186\/s40360-024-00767-1"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"dead093.678","DOI":"10.1093\/humrep\/dead093.678","article-title":"P-320 Change of bone mineral density after long-term use of dienogest with calcium and vitamin D supplementation after surgical treatment of endometrioma","volume":"38","author":"Park","year":"2023","journal-title":"Hum. Reprod."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"20503121211005992","DOI":"10.1177\/20503121211005992","article-title":"Ovarian reserve may influence the outcome of bone mineral density in patients with long-term use of dienogest","volume":"9","author":"Yamamoto","year":"2021","journal-title":"SAGE Open Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1556","DOI":"10.1007\/s43032-020-00453-7","article-title":"The long-term effect of dienogest on bone mineral density after surgical treatment of endometrioma","volume":"28","author":"Kim","year":"2021","journal-title":"Reprod. Sci."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7062\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T12:35:02Z","timestamp":1789130102000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/18\/7062"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,11]]},"references-count":46,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15187062"],"URL":"https:\/\/doi.org\/10.3390\/jcm15187062","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,11]]}}}