Radiologic Evaluation of Patients with Glioblastoma Multiforme who Initially Presented with Ischemic Stroke: A Case Series

Yasaman Arjmand¹, Pooya Torkian¹ and Ali Keipourfard^2,

¹Department of Radiology, Shohada Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

²Department of Orthopedics Surgery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Cite this paper

Yasaman Arjmand, Pooya Torkian and Ali Keipourfard. Radiologic Evaluation of Patients with Glioblastoma Multiforme who Initially Presented with Ischemic Stroke: A Case Series. American Journal of Medical Case Reports. 2017; 5(1):8-11. doi: 10.12691/AJMCR-5-1-3

Abstract

Background: Glioblastoma multiform (GBM) is the most common primary brain tumor. Few studies have described the clinical and radiological aspects of GBMs in which initial manifestation mimics vaso-occlusive diseases and transient ischemic attacks (TIAs). In this study, we have described 10 patients with GBM who initially presented with ischemic attacks. Case Description: From August 2008 to June 2016, 332 patients with confirmed GBM by histopathological study were referred to Shohada Tajrish Hospital. Of this population, 10 cases initially presented with isolated acute ischemic/vaso-occlusive symptoms and TIA episodes. All of the patients underwent imaging and surgical procedures with confirmed histopathological diagnosis of GBM. Conclusions: GBMs involving fronto-temporal and temporal lobes may compress and invade MCA branches and cause acute ischemic stroke as their initial manifestation. Although rare, GBMs should be considered in differential diagnosis in patients with no obvious atherosclerotic risk factors who present with ischemic stroke.

Keywords

glioblastoma multiforme, initial presentation, transient ischemic attack, imaging, middle cerebral artery

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Wen, P.Y., Kesari, S., “Malignant gliomas in adults,” New England Journal of Medicine, 359(5). 492-507. 2008.
[2]	Chakrabarti, I., Cockburn, M., Cozen, W., Wang, Y.P., Preston‐Martin, S., “A population‐based description of glioblastoma multiforme in Los Angeles County, 1974-1999,” Cancer, 104(12). 2798-806. 2005.
[3]	Preusser, M., de Ribaupierre, S., Wöhrer, A., Erridge, S.C., Hegi, M., Weller, M., Stupp, R., “Current concepts and management of glioblastoma,” Annals of neurology, 70(1). 9-21. 2011.
[4]	Farrell, C.J., Plotkin, S.R., “Genetic causes of brain tumors: neurofibromatosis, tuberous sclerosis, von Hippel-Lindau, and other syndromes,” Neurologic clinics, 25(4). 925-46. 2007.
[5]	Madhusoodanan, S., Danan, D., Moise, D., “Psychiatric manifestations of brain tumors: diagnostic implications.” Expert review of neurotherapeutics, 7(4). 343-9. 2007.
[6]	Dearborn, J.L., Urrutia, V.C., Zeiler, S.R., “Stroke and cancer-a complicated relationship. Journal of neurology & translational neuroscience,” 2(1). 1039. 2014.
[7]	Louis, D.N., Ohgaki, H., Wiestler, O.D., Cavenee, W.K., Burger, P.C., Jouvet, A., Scheithauer, B.W., Kleihues, P., “The 2007 WHO classification of tumours of the central nervous system,” Acta neuropathologica, 114(2). 97-109. 2007.
[8]	Carlsson, S.K., Brothers, S.P., Wahlestedt, C., “Emerging treatment strategies for glioblastoma multiforme,” EMBO molecular medicine, 6(11). 1359-70. 2014.
[9]	Li, W.B., Tang, K., Chen, Q., Li, S., Qiu, X.G., Li, S.W., Jiang, T., “MRI manifestions correlate with survival of glioblastoma multiforme patients,” Cancer Biology & Medicine, 9(2). 120-3. 2012.
[10]	Mukundan, S., Holder, C., Olson, J.J., “Neuroradiological assessment of newly diagnosed glioblastoma,” Journal of neuro-oncology, 89(3). 259-69. 2008.
[11]	Horská, A., Barker, P.B., “Imaging of brain tumors: MR spectroscopy and metabolic imaging,” Neuroimaging clinics of North America, 20(3). 293-310. 2010.
[12]	Sturm, D., Bender, S., Jones, D.T., Lichter, P., Grill, J., Becher, O., Hawkins, C., Majewski, J., Jones, C., Costello, J.F., Iavarone, A., “Paediatric and adult glioblastoma: multiform (epi) genomic culprits emerge,” Nature reviews Cancer, 14(2). 92-107. 2014.
[13]	Latchaw, R.E., Yonas, H., Hunter, G.J., Yuh, W.T., Ueda, T., Sorensen, A.G., Sunshine, J.L., Biller, J., Wechsler, L., Higashida, R., Hademenos, G., “Guidelines and recommendations for perfusion imaging in cerebral ischemia a scientific statement for healthcare professionals by the writing group on perfusion imaging, from the council on cardiovascular radiology of the American heart association,” Stroke, 34(4). 1084-104. 2003.
[14]	Seddighi, A., Akbari, M.E., Seddighi, A.S., Pirayesh, E., Soleymani, M.M., Baqdashti, H.R., Nikouei, A., Zali, A., Tabatabaei, S.M., Naimian, S., Mellati, O., “Radioguided surgery using gamma detection probe technology for resection of cerebral glioma,” Hellenic journal of nuclear medicine, 18. 68-75. 2014.
[15]	Cheng, H.T., Wang, C.C., Chio, C.C., Kuo, J.R., “Sphenoid ridge meningioma presenting as ischemia stroke,” ANZ journal of surgery, 81(10). 751-2. 2011.
[16]	Aoki, N., Sakai, T., Oikawa, A., Takizawa, T., Koike, M., “Dissection of the middle cerebral artery caused by invasion of malignant glioma presenting as acute onset of hemiplegia,” Acta neurochirurgica, 141(9). 1005-8. 1999.
[17]	Chen, H., Cebula, H., Schott, R., Dietemann, J.L., Froelich, S., “Glioblastoma multiforme presenting with ischemic stroke: case report and review of the literature,” Journal of Neuroradiology, 38(5). 304-7. 2011.
[18]	Pina, S., Carneiro, Â., Rodrigues, T., Samões, R., Taipa, R., Melo-Pires, M., Pereira, C., “Acute Ischemic Stroke Secondary to Glioblastoma A Case Report,” The neuroradiology journal, 27(1). 85-90. 2014.
[19]	Amelot, A., Baronnet-Chauvet, F., Fioretti, E., Mathon, B., Cornu, P., Nouet, A., Chauvet, D., “Glioblastoma complicated by fatal malignant acute ischemic stroke: MRI finding to assist in tricky surgical decision,” The neuroradiology journal, 28(5). 483-7. 2015.
[20]	Hardee, M.E., Zagzag, D., “Mechanisms of glioma-associated neovascularization,” The American journal of pathology, 181(4). 1126-41. 2012.
[21]	Mull, M., Schwarz, M., Thron, A., “Cerebral hemispheric low-flow infarcts in arterial occlusive disease lesion patterns and angiomorphological conditions,” Stroke, 28(1). 118-23. 1997.
[22]	Seddighi, A., Seddighi, A.S., Nikouei, A., Mohseni, G., “NS-06 IMAGE GUIDED SURGERY USING NEURONAVIGATION SYSTEM IN RESECTION OF CEREBRAL GLIOMAS INVOLVING ELOQUENT CORTICAL AREAS IN PEDIATRIC POPULATION,” Neuro-Oncology, 18(suppl 3). iii128-. 2016.
[23]	Stroke Study Group, “Tissue plasminogen activator for acute ischemic stroke,” New England Journal of Medicine, 333. 1581-8. 1995.