Teaching Case

Admitted to the hospital with symptoms of raised intracranial pressure. Five months before he had fever, several episodes of seizure, aphasia and a progressive right hemiplegia

The patient was admitted to the hospital with symptoms of raised intracranial pressure. Five months before he had fever, several episodes of seizure, aphasia and a progressive right hemiplegia. A CT scan of the brain showed several hemispheric lesions suggesting the diagnosis of encephalitis. Biopsy was performed but remained inconclusive. Therefore, the patient was referred for diagnosis and treatment. Clinical examination confirmed the right hemiplegia and aphasia, but also revealed palsy of several cranial nerves. CT scan and MRI of the brain were carried out.

Glioblastoma multiforme (or malignant astrocytoma grade IV) is uncommon in childhood, representing only 2% of all intracranial neoplasms. The prognosis is very poor with less than 5% 5-year survival in spite of surgical resection. Extra-cranial metastases to lungs and lymph nodes, less commonly to bone and liver, have been described. MRI is more sensitive for detection and exact location of the tumor than CT scan. However the appearance of the lesions is highly variable and hence not specific. Tissue confirmation by biopsy remains necessary. To classify gliomas several parameters must be evaluated: presence of edema or mass effect, signal heterogiography of the tumor, presence of hemorrhage, cystic formation or necrosis and tumor margins. Administration of contrast medium is useful for better definition of the borders and to detect small deposits, but is not an absolute predictor of malignancy.