Dual pathology is a well-known cause of temporal lobe epilepsy (TLE), but TLE associated with dual pathology within the hippocampus has rarely been reported. We describe a patient with medically refractory TLE due to a focal cortical dysplasia of the end folium of the left hippocampus (i.e. CA4) and left hippocampal sclerosis (HS) that was successfully treated with left anterior temporal lobectomy and speculate on the interaction between end folium sclerosis and HS.