Aymeric Amelot1, Flore Baronnet-Chauvet2, Edith Fioretti3, Bertrand Mathon4, Philippe Cornu4, Aurélien Nouet4, Dorian Chauvet4. 1. Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France aymmed@hotmail.fr. 2. Stroke Unit, Hôpital La Pitié Salpétrière, APHP, Paris, France. 3. Department of Radiology, Hôpital European Georges Pompidou, APHP, Paris, France. 4. Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France.
Abstract
BACKGROUND: In most cases, glioblastomas are associated with seizures, headaches, neurological deficits, aphasia, or bleeding. But these tumors are rarely associated with cerebral infarction and never so deadly. CASE REPORT: A 40-year-old man presented with sudden morning isolated aphasia. One hour later, he developed a motor deficit at right upper member, quickly completed with a total right hemiplegia. Imaging studies revealed a left frontotemporal enhancing glioblastoma with a perilesional edema which produced an important mass effect on the posterior arm of the external capsule, on the primary motor cortex posteriorly and the entire sylvian valley anteriorly. Due to major surgical risks associated with left middle cerebral artery (MCA) inclusion and large edema, we decided to postpone the tumor removal and introduce quickly high concentrations of steroids. Twenty-four hours after his admittance, the patient presented a sudden impaired consciousness, coma, and a left mydriasis. A brain magnetic resonance image (MRI) revealed a left malignant MCA infarction, deadly for the patient. CONCLUSION: To our knowledge, glioblastomas complicated by fatal ischemic stroke have not been reported. We discuss the pathology of such an event and try to figure out if it was predictable based on MRI finding, and inevitable with precocious surgery.
BACKGROUND: In most cases, glioblastomas are associated with seizures, headaches, neurological deficits, aphasia, or bleeding. But these tumors are rarely associated with cerebral infarction and never so deadly. CASE REPORT: A 40-year-old man presented with sudden morning isolated aphasia. One hour later, he developed a motor deficit at right upper member, quickly completed with a total right hemiplegia. Imaging studies revealed a left frontotemporal enhancing glioblastoma with a perilesional edema which produced an important mass effect on the posterior arm of the external capsule, on the primary motor cortex posteriorly and the entire sylvian valley anteriorly. Due to major surgical risks associated with left middle cerebral artery (MCA) inclusion and large edema, we decided to postpone the tumor removal and introduce quickly high concentrations of steroids. Twenty-four hours after his admittance, the patient presented a sudden impaired consciousness, coma, and a left mydriasis. A brain magnetic resonance image (MRI) revealed a left malignant MCA infarction, deadly for the patient. CONCLUSION: To our knowledge, glioblastomas complicated by fatal ischemic stroke have not been reported. We discuss the pathology of such an event and try to figure out if it was predictable based on MRI finding, and inevitable with precocious surgery.
Authors: D Kondziolka; M Bernstein; L Resch; C H Tator; J F Fleming; R G Vanderlinden; H Schutz Journal: J Neurosurg Date: 1987-12 Impact factor: 5.115