A 57-year-old man was brought to the emergency department with severe bifrontal headache, which he had had for 3 weeks. Family members reported that the patient exhibited episodes of confusion and loss of recent memory since the onset of the headache.
The patient denied nausea and vomiting, fever, visual disturbances, seizures, and weakness of the extremities. The physical examination revealed bilateral papilledema; all other findings, including those regarding higher mental function, were normal. Routine laboratory test results and chest film findings were within normal limits.
Drs Thomachan Kalapura and Viswanatha Kurukundha of New York Methodist Hospital in Brooklyn point out that a CT scan with contrast demonstrated a large heterogeneous mass with peripheral enhancement in the left frontal lobe, with surrounding edema and midline shift (A). Intravenous corticosteroids were given, and the patient responded with mild clinical improvement. An MRI showed the same mass, edema, and midline shift. A subtotal resection of the tumor was performed; no focal deficits resulted.
The pathologic examination of the lesion confirmed the clinical suspicion of glioblastoma multiforme.
Characteristic areas of hypercellularity and cellular atypia (B, double arrows) and central necrosis (B, single arrows) were seen. Vascular and endothelial cell proliferation (C, arrow) was also detected in a glioblastomatous background.
The patient is being treated currently with cranial irradiation.