- Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, 1st Neurosurgery Clinic, 06110 Ankara, Turkey
Ahmet Metin Sanli
Ministry of Health Diskapi Yildirim Beyazit Education and Research Hospital, 1st Neurosurgery Clinic, 06110 Ankara, Turkey
DOI:10.4103/2152-7806.74146© 2010 Sanli AM This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Sanli AM, Turkoglu E, Dolgun H, Sekerci Z. Unusual manifestations of primary Glioblastoma Multiforme: A report of three cases. Surg Neurol Int 22-Dec-2010;1:87
How to cite this URL: Sanli AM, Turkoglu E, Dolgun H, Sekerci Z. Unusual manifestations of primary Glioblastoma Multiforme: A report of three cases. Surg Neurol Int 22-Dec-2010;1:87. Available from: http://sni.wpengine.com/surgicalint_articles/unusual-manifestations-of-primary-glioblastoma-multiforme-a-report-of-three-cases/
Background:Brain tumors, especially high-grade gliomas, can present with focal or generalized signs due to mass effect, parenchymal infiltration and destruction. In general, at the time of diagnosis, tumors could cause common neurological symptoms and major clinical signs depending on their localization. In rare instances, brain tumors colud be manifested with unusual symptoms.
Case Description:We describe three cases presenting with unusual clinical symptoms: ulnar neuropathy, vertigo and syncope attacks. Microscopic total tumor excision was done and histopathological analysis revealed that these tumors were glioblastoma multiforme. Both external beam radiotherapy and chemotherapy were given as adjuvant treatments.
Conclusions:Physicians should keep brain tumors in mind in the case of patients who present with atypical symptoms such as those reported here. Brain imaging should be performed over a prolonged period following presentation if the patient’s symptoms remain unresolved after adequate treatment.
Keywords: Astrocytoma, brain tumor, glioblastoma multiforme, presentation, symptom
Astrocytomas, including glioblastoma multiforme (GBM), are the most common malignant central nervous system (CNS) tumors in neurosurgical practice.[
A 42-year-old man was admitted with progressive tingling, paresis and hypoesthesia of his left hand through an orthopedic clinic. Electromyography and nerve conduction studies revealed that the velocity of the ulnar nerve was slowed between the elbow and 2 cm site above of elbow [
A 46-year-old man presented with multiple syncope attacks. The patient felt faint and then passed out. The physician did not think that these drop attacks were secondary to seizure activity. Six months earlier, he had begun to notice intermittent headaches. He applied to our emergency department with confusion, a severe headache and left side hemiparesis and hemihypoesthesia. He was referred to a neurology clinic, and a right parieto-occipital intracerebral hematoma was detected on cranial MRI. Our differential diagnosis included intracranial malignancies,[
(a) T1-weighted axial cranial MRI without contrast revealing a hypointense lesion in the left parieto-occipital region causing a minimal midline shift (b) MR spectroscopy demonstrated an increased lactate peak, decreased N- acetylaspartate (NAA) peak and creatinin (Cr). These findings suggest that the appearance could be geared to acute intracerebral hematoma
(a, b) Cranial MRI with gadolinium revealing a 6 × 5 × 4 cm left-sided parieto-occipital lesion with brain edema, associated mass effect and uncal herniation. The lesion was composed of cystic tissue separated by various fibrous septae. The tumor was hyperintense on T1-(a) and T2-(b) weighted images and showed heterogeneous enhancement with contrast peripherally.
A 70-year-old woman presented with progressive and continuous vertigo for six months. She had complained about right-sided otalgia and bilateral hearing loss without tinnitus and applied to the ear, nose, and throat (ENT) clinic. The patient had a normal ear examination but audiometry demonstrated 60-70 dB moderate sensorineuronal hearing loss bilaterally. Neurological examination was normal except left-sided nystagmus. Cranial axial MRI with contrast revealed a 1.5 × 2 cm nodular tumor in the right lateral recess of forth ventricle [
Pre-operative evaluation of patients with possible brain lesions requires a careful history and physical examination followed by radiological examination. Patients with high-grade gliomas (HGG) often present with headache, new-onset seizures, altered mental functions[
Patients with primary GBM characteristically present with focal or generalized symptoms as mentioned above. Because GBM is the most common primary brain tumor, there are many instances of unusual presentations. These including, but are not limited to unusual seizures patterns (e.g. musicogenic epilepsy, reflex epilepsy),[
Despite the attempts to classify symptoms as focal or generalized and to determine GBM locations, clinical situations are nonspecific and unreliable. Therefore, physicians should keep brain tumors in mind in the case of patients who present with atypical symptoms such as those reported here. Consequently, brain imaging should be performed over a prolonged period following presentation if the patient’s symptoms remain unresolved after adequate treatment. High suspicion of GBM is mandatory in patients over 40 years of age who present with changes in neurological status.
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