Cystic Glioblastoma of the Third Ventricle: Diagnostic Challenges and Poor Functional Outcome Related to Cystic Haemorrhage

Abstract

<i>Background: </i>Glioblastoma multiforme (GBM) is the most common intra-axial primary brain tumour in adults, and prognosis is poor. Spontaneous haemorrhage is an uncommon but recognized initial presenting sign of primary brain tumour. Moreover, intra-cystic haemorrhage is frequent, further can affect functional outcome and even reducing survival duration. Most GBM tumours arise in the frontotemporal region, haemorrhagic cystic GBM arise in the third ventricle of the brain is very rare and create a diagnostic dilemma and surgical challenges. Third ventricular GBM can arise from structures on or near the third ventricle wall. Patients with massive intra-cystic haemorrhage can present with a wide spectrum of clinical signs and symptoms related to increased intracranial pressure (ICP), ranging from headache to sudden acute neurological deterioration, coma, and death. Acute deterioration frequently results from massive acute haemorrhage inside the cystic component leading to hydrocephalus, especially when the tumour mass obstructs the foramen of Monro. Due to high tumour-related mortality and sudden death related to acute hydrocephalus, A high index of suspicion is required to avoid misdiagnosis and delayed surgical treatment due to the atypical anatomic and radiologic presentation of cystic haemorrhagic GBM. This case presentation highlights the significant role of haemorrhage inside the GBM cystic component on both diagnosis and clinical course of the disease.