Acute viral ensefalitis and glioblastoma multiforme; 2 case reports

Abstract

Viral encephalitis is an acute febrile disease, manifested by changes in consciousness, focal neurological findings, and seizures, causing damage to the parenchymal tissue of the central nervous system. Glioblastoma multiforme (GBM) is the most malignant astrocytic tumor that is mostly supratentorial, multifocal/multicentric, with low differentiation, vascular proliferation, necrosis, and intense infiltration into surrounding tissues. A 55-year-old male patient was evaluated in the emergency department due to a sudden onset of consciousness change and behavior disorder. Leukocytosis and T2-FLAIR hyperintense lesion in the left temporal lobe were detected (Fig. 1). LP couldn’t be performed because it was not allowed. The patient improved with treatment. The control brain imaging revelead growing lesion and contrast enhancement. He had undergone operation and diagnosed as GBM. A 63-year-old male patient was observed with seizures when he evaluated in the emergency department because of blurring of consciousness. Diffusion restriction was observed in the medial of left temporal lobe. He hospitalized with the diagnosis of encephalitis and started treatment. The patient's cerebrospinal fluid HSVtype2 IgM was positive. After evaluating the atypical contrast enhancement on control MRI (Fig. 2) the patient was operated and diagnosed as GBM. In the first case, the patient who presented with acute onset encephalitis clinic was diagnosed with GBM in our follow-up, while in the second case the presence of concurrent GBM was noted of the patient who was diagnosed with definite encephalitis by viral markers. For evaluation of patients with encephalitis, high-grade brain tumors should be considered for bearer and additional diagnosis and followed up clinically/radiologically.