Glioblastoma multiforme: Case report of an unusual presentation

Abstract

Abstract Glial tumors account for about 60% of all primary brain tumors. About one-third of patients suffer deficits in one or more cognitive domains, of which language difficulties may be mistaken for confusion. A 60-year-old male who was brought to the medical outpatient department (OPD) on November 14, 2022, with complaints of mental confusion, talking irrelevantly, and increased sleep for 20 days. As the patient had irrelevant talk, he was referred to psychiatry OPD. The psychiatric evaluation revealed word-finding difficulty, memory impairment, and confabulation. His physical examination was normal, but the Montreal Cognitive Assessment Scale score was 8. A provisional diagnosis of organic amnesic syndrome, not induced by alcohol and other psychoactive substances (F04), was made. Plain computed tomography scan brain revealed a large cystic and solid lesion in the left capsuloganglionic region extending to left thalamic and temporal regions with severe perilesional vasogenic edema suggestive of glioblastoma multiforme with midline shift of 5.6 mm. The case was immediately referred to the neurosurgery department for further management. He was treated there with dexamethasone to reduce edema and was referred to a cancer center for chemotherapy and radiotherapy. The patient was put on chemotherapy and passed away on January 21, 2023, before that could happen. Any case with recent onset of neuropsychiatric symptoms needs thorough cognitive assessment and a high index of suspicion to rule out organic causes. Informed consent to submit the case report for publication was obtained from the son of the patient.