To describe the neurobehavioral and neurological complications associated with post-surgical encephalomalacia after thalamic cavernoma resection.

Thalamic cavernomas are rare vascular malformations and surgical management carries significant risk due to the proximity of critical limbic and hypothalamic structures. Postoperative complications may result in complex neurological and behavioral syndromes. We present a case of postoperative encephalomalacia manifesting with hyperphagia, emotional lability, and motor deficits following thalamic cavernoma resection.

A single-patient case study was conducted through clinical evaluation and chart review. Relevant postoperative findings and medical history were compiled from inpatient and outpatient electronic medical records.

A 58-year-old woman underwent left thalamic cavernoma resection with ventriculoperitoneal shunt placement in 2013 following hemorrhagic rupture. Postoperatively, she developed compulsive hyperphagia, right-sided hemiparesis, diplopia, mild expressive aphasia, anxiety, and profound emotional lability. Before surgery, she had no prior history of these symptoms. Follow-up MRI demonstrated stable shunt function, right frontal lobe encephalomalacia, additional encephalomalacia in the left frontal and temporal lobes, and pre-existing probable left anterior temporal gliosis with volume loss. The patient required strict dietary supervision, physical and occupational therapy, and medication management with sertraline for anxiety and hyperphagia. Despite partial improvement, she remains emotionally fragile and requires food regulation to prevent overconsumption.

This case demonstrates the profound behavioral and physical consequences of structural injury to the thalamic, hypothalamic and frontal lobe regions. Post surgical encephalomalacia in this region can disrupt essential functions like hunger, emotional regulation, and impulse control resulting in mood dysregulation and hyperphagia. Multidisciplinary intervention including neuropsychiatric care, nutritional management, and targeted rehabilitation are critical for optimizing stability and quality of life.