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Initial magnetic resonance imaging (MRI) scan of the brain was reported as normal; however, a repeat MRI of the brain (see Figure 101) was reported to be signi cant for left mesial temporal (hippocampal) sclerosis Video EEG monitoring (see Figure 102) was reported to be signi cant for epileptiform discharges from the left temporal area consistent with the MRI ndings Finally, a positron emission tomography scan was reported to be signi cant for decreased accumulation within the anterior left temporal lobe As result, Zoey underwent epilepsy surgery (left temporal lobectomy with removal of the hippocampus and amygdala) Since the surgery, Zoey s mother reports that Zoey has not experienced any actual seizures; however, she does report auras approximately three times a week The auras are characterized by similar feelings from her stomach that emanate to her head.

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much larger force and becoming an indispensable part of this important structure. As such, they often share hallmarks with the narcissistic personality, although these more inflated qualities are but skin-deep. Like the conscientious compulsive, the bureaucratic compulsive often shades gently into normality, but individual differences run the spectrum from nearly normal to wholly forceful. At a moderately disordered level, their rigid adherence to policies and rules makes them seem officious, high-handed, close-minded, and petty. At a severely disordered level, they may use their knowledge of the rules, effectiveness with red tape, and ingratiating attitude with superiors to terrorize subordinates or anyone else who crosses their path without paying them the proper dues and respect. Donald has some traits of the bureaucratic compulsive in that he is obviously a company man, but he doesn t derive pleasure from control. As a middle-level manager, he could potentially exert a great amount of control over his underlings, but he does not take advantage of this opportunity. Holden, in Case 7.2, is a better example. Notice his relationships with his superiors and with his students.

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She may then see black for a few seconds after which she returns to normal At present, Zoey continues taking Topamax for seizure control In addition, she takes amitriptyline (Elavil) for management of migraine headaches At her neurologist s request, postoperative neuropsychological evaluation was undertaken in order to monitor higher cortical functioning approximately four years after her surgery in accordance with the Pediatric Epilepsy Surgery Protocol..

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