Multifocal glioblastoma multiform with “encephalitis-like presentation” : a case report (original) (raw)
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Glioblastoma mimicking herpes simplex encephalitis
Journal of Korean Neurosurgical Society, 2011
We report a case of 70-year-old man with glioblastoma presenting as acute encephalitic illness. The patient exhibited sudden onset of cognitive impairment and headache for 2 days. Initial brain MRI showed left temporal lobe hyperintensity, and cerebrospinal fluid cytology revealed a mild pleocytosis. The patient had initially improved after medical treatment with a presumptive diagnosis of herpes simplex encephalitis (HSE). After 8 months, the patient complained of recurrent seizures. A follow-up brain MRI revealed marked increases in size and surrounding perilesional edema in the left temporal lesion on T2-weighted images and a new contrast-enhancing lesion on gadolinium-enhanced T1-weighted images. Stereotactic brain biopsy revealed a glioblastoma. The atypical encephalitic presentation of glioblastoma should be considered if definitive evidence for the diagnosis of HSE cannot be obtained.
Possible Viral Etiology of Glioblastoma Multiforme
Bozok Tıp Dergisi, 2021
Objective: Recently, CMV, EBV, BKV and JC virus have been suggested to contribute to gliomagenesis, but evidence is largely contradictory. The aim of this study was to test 50 tissue samples from patients with GBM and 21 normal brain tissues obtained from autopsy material of patients without brain tumors in order to investigate the presence of possible oncogenic microorganisms, including EBV, JCV, BKV and Toxoplasma gondii, and to evaluate patient clinical characteristics of patients with respect to microorganism findings. Material and Method: Fifty formalin-fixed paraffin-embedded specimens obtained from glioblastoma tissue and 21 normal brain tissues obtained in the autopsy of individuals without brain tumor were retrospectively analyzed. After de-paraffinization of tissue samples, DNA extraction was performed for real-time polymerase chain reaction (RT-PCR) analysis to detect BKV, JCV, EBV and Toxoplasma gondii via commercially-available multiplex kits. Results: Strikingly, viral...
Acta Bio Medica : Atenei Parmensis, 2019
Herpes simplex virus encephalitis (HSE) is the most common cause of letal encephalitis and its prevalence appears higher among oncologic patients who undergo brain radiotherapy (RT). We describe a case of 76-year-old woman with glioblastoma multiforme (GBM) who developed HSE shortly after brain RT. Cerebrospinal fluid analysis (CSF) was normal and the diagnosis was driven by brain MRI and EEG. Prompt introduction of antiviral therapy improved the clinical picture. We highlight the importance of EEG and brain MRI for the diagnosis and suggest the possibility of antiviral profilaxys in oncologic patients who undergo brain RT. (www.actabiomedica.it)
Anaplastic astrocytoma mimicking herpes simplex encephalitis in 13-year old girl
Astrocytoma is the most common childhood brain tumor. Anaplastic astrocytoma (AA) are high grade gliomas (HGG), found very rarely in pediatric patients. AA mainly results from a dedifferentiation of a low grade astrocytoma. Clinical features of supra-tentorial tumors vary according to their anatomic location, biologic aggressiveness and age of the patient. They can be either completely asymptomatic or present with signs of raised intracranial pressure, seizures (about 40% of cases), behavior changes, speech disorders, declining school performance , or hemiparesis. There have been published adult cases of brain tumor misdiagnosed as viral encephalitis. Due to variety of clinical presentations, diagnosis of AA can be challenging. Here we report a case of a 13 year old girl who presented with clinical features suggestive of viral encephalitis, such as fever, headache, dizziness, and first seizure with postictal sleep and prolonged drowsiness. However, her brain MRI findings were consistent with long standing mass effect from the underlying intracranial contents and that coupled with her history of unusual taste led to further investigations and the diagnosis of the AA. In retrospect, this presentation could have been a temporal epileptic aura. High grade astrocytomas are particularly difficult to treat with a two-year survival rates range from 10% to 30%. The treatment is multimodal with gross total surgical resection of the tumor, followed by radiotherapy with or without nitrosourea-containing chemotherapy regimen. Recent promising results seen with the use of temozolamide in adults has not been yet demonstrated in the pediatric patients. The extent of tumor resection remains the most significant indicator of survival and early recognition of this tumor is essential. This case report emphasizes the fact that mass lesions in the temporal lobe, including high-grade astrocytoma, should be considered in the differential diagnosis of suspected herpes simplex encephalitis, especially those not responding to therapy. Remodeling of the calvarium adjacent to an intracranial lesion suggests a long standing process. e u r o p e a n j o u r n a l o f p a e d i a t r i c n e u r o l o g y 1 9 (2 0 1 5) 7 2 2 e7 2 5
Unusual magnetic resonance imaging appearance of multiple cystic lesions in glioblastoma multiforme
Turkish neurosurgery, 2013
The differential diagnosis of multiple ring-enhancing intraaxial lesions includes neoplastic, infectious, inflammatory, demyelinating and vascular lesions. We report a case of a 41-year-old man who presented with a brief history of left lower extremity weakness and sensory loss. Magnetic resonance imaging demonstrated multiple ring-enhancing lesions in the right frontal and parietal lobes. Neuroradiology interpretation was felt to be unlikely for a neoplastic process. The patient underwent stereotactic brain biopsy, which was diagnostic for glioblastoma multiforme. This case demonstrates the importance of histological confirmation of intraaxial brain lesions whenever feasible. The course of his disease and treatment are discussed and the literature reviewed.
Unusual manifestations of primary Glioblastoma Multiforme: A report of three cases
Surgical Neurology International, 2010
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.
Glioblastoma Mimicking Viral Encephalitis Responds to Acyclovir
Frontiers in Oncology, 2019
Viral encephalitis and glioblastoma are both relatively rare conditions with poor prognoses. While the clinical and radiographic presentations of these diseases are often distinctly different, viral encephalitis can sometimes masquerade as glioblastoma. Rarely, glioblastoma can also be misdiagnosed as viral encephalitis. In some cases where a high-grade glioma was initially diagnosed as viral encephalitis, antiviral administration has proven effective for relieving early symptoms. We present three cases in which patients presented with symptoms and radiographic findings suggestive of viral encephalitis and experienced dramatic clinical improvement following treatment with acyclovir, only to later be diagnosed with glioblastoma in the region of suspected encephalitis and ultimately succumb to tumor progression.
Simultaneous radiologic isolated syndrome and glioblastoma multiforme in an adult patient
International Clinical Neuroscience Journal, 2016
A young known case of multiple sclerosis was evaluated with chief complaint of gradually progressed left lower limb weakness over 3 weeks. Pathologic examination of a mass in brain magnetic resonance imaging confirmed the diagnosis of glioblastoma multiforme (GBM). Given the importance of the definite diagnosis of malignant glioma and its effect on patient’s management, GBM should be considered as a differential diagnosis in cases with coexisting mass like lesion and demyelinating plaques.
Glioblastoma Multiforme with Atypical Appearance
Revista de Chimie, 2019
We present the case of a 68-year-old patient who is hospitalized in our clinic for cognitive and attention disorders, progressively progressing over the past three months. The neurological examination revealed, besides cognitive decline, a motor deficit in the right limbs, and mild swallowing disorders for liquids. Although both CT and MRI were performed, the images obtained from the investigations were inconclusive, raising differential diagnosis problems. The patient was subjected to additional investigations, but the diagnosis of certainty was established by performing sterotactic biopsy and histological examination. Although cerebral MRI is the investigation of choice in the diagnosis of glioblastoma, in our patient�s case, the diagnosis of certainty was determined by stereotactic biopsy and subsequent histological examination.