Atypical Presentation of Glioblastoma Multiforme

  • Wissam Al-Janabi Neurology Department, Henry Ford Health System, Detroit, MI, USA
  • Renee Krebs Neurology Department, Henry Ford Health System, Detroit, MI, USA
  • Ximena Arcila-Londono Neurology Department, Henry Ford Health System, Detroit, MI, USA
  • Iram Zaman Neurology Department, Henry Ford Health System, Detroit, MI, USA
  • Bashiruddin K Ahmad Neurology Department, Henry Ford Health System, Detroit, MI, USA


Glioblastoma multiforme, primary care physician, World Health Organization, emergency department, cerebrospinal fluid


Background: Glioblastoma multiforme (GBM) is a highly malignant glial tumour classified by the World Health Organization (WHO) as a stage IV astrocytoma. It varies in shape and size and can be cystic, vascular and necrotic. It often appears as a ring-enhancing lesion on magnetic resonance imaging (MRI). The most common symptoms of GBM, such as headache, vomiting and seizures, are due to increased intracranial pressure. The objective of this case report is to describe an atypical presentation of GBM.
Case Report: A 53-year-old woman of Italian origin presented with a 2-week history of lack of coordination in her hands and some difficulty in speech. Electromyography for assessment of her arms and cranial bulbar function was normal. However, 2 days later, the patient presented to the emergency department with progressive weakness in her left arm and leg as well as difficulty in speech. Mild left facial asymmetry was noted. A brain MRI revealed a right frontal mass. Stereotactic surgical resection was performed 2 days later, and biopsy confirmed the diagnosis of GBM. Although headache and other features of raised intracranial pressure are the most common initial symptoms of GBM, any atypical neurological or psychiatric presentation in an adult patient should raise suspicion for this tumour.
Conclusion: Careful analysis of an adult with atypical signs and symptoms along with thorough review of radiological tests will facilitate early diagnosis of dangerous tumours such as GBM.



  • Daroff R, Jankovic J, Mazziotta J, Pomeroy S. Bradley's neurology in clinical practice. 7th ed. London: Elsevier Health Sciences; 2015.

  • Zhang YY, Ruan LX, Zhang S. Rapid progression of glioblastoma multiforme: a case report. Oncol Lett 2016;12:4803–4806.

  • Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, editors. WHO classification of tumours of the central nervous system. Vol 1. 4th ed. Lyon: IARC Press; 2007.

  • Sanli AM, Turkoglu E, Dolgun H, Sekerci Z. Unusual manifestations of primary glioblastoma multiforme: a report of three cases. Surg Neurol Int 1;87:2010.

  • de Castro-Costa CM, de Araújo RW, de Arruda MA, de Araújo PM, de Figueiredo EG. Increased intracranial pressure in a case of spinal cervical glioblastoma multiforme. Analysis of these two rare conditions. Arq Neuropsiquiatr 1994;52:64–68.

  • Wen PY, Kesari S. Malignant gliomas in adults. N Engl J Med 2008;359:492–507.

  • Furneaux CE, Marshall ES, Yeoh K, Monteith SJ, Mews PJ, Sansur CA, et al. Cell cycle times of short-term cultures of brain cancers as predictors of survival. Br J Cancer 2008;99:1678–1683.

  • Cvetkoiv?-Doži? D, Skender-Gazibara M, Doži? S. Morphological and molecular features of diffuse infiltrating astrocytoma. Arch Oncol 2004;12:38–39.

  • Lakhan SE, Harle L. Difficult diagnosis of brainstem glioblastoma multiforme in a woman: a case report and review of the literature. J Med Case Rep 2009;3:87.

  • Levine SA, McKeever PE, Greenberg HS. Primary cerebellar glioblastoma multiforme. J Neurooncol 1987;5:231–236.

  • Kleihues P, Burger PC, Collins VP, Cavenee WK, editors. World Health Organization classification of tumours. Pathology and genetics of tumours of the nervous system. Lyon: IARC Press; 2000.

  • Katsetos CD, Dráberová E, Legido A, Dráber P. Tubulin targets in the pathobiology and therapy of glioblastoma multiforme. II. gamma-Tubulin. J Cell Physiol 2009;221514–520.

  • Bradley WL. Case of gliosarcomatous tumors of the brain. Proc Conn Med Soc 1880;2:39–41.

  • Boele FB, Rooney AR, Grant, RG, Klein MK. Psychiatric symptoms in glioma patients: from diagnosis to management. Neuropsychiatr Dis Treat 2015;11:1413–1420.
  • Published: 2018-09-12

    Issue: Vol 5 No 9 (view)

    Section: Articles

    How to cite:
    Al-Janabi W, Krebs R, Arcila-Londono X, Zaman I, Ahmad BK. Atypical Presentation of Glioblastoma Multiforme. EJCRIM 2018;5 doi:10.12890/2018_000954.