Glioblastoma multiforme hiding behind the intracerebral hematoma

Abstract

A previously healthy man experienced a headache and confusion for 3 weeks. A cranial computerized tomography (CT) scan showed a resolving lobar intracerebral hemorrhage (ICH) in the right frontal lobe. A stereotactic aspiration of the ICH was performed to relieve the mass, and biopsy was reported to only show hematoma. However, the patient continued to have a persistent headache and unsteady gait even 2 months after surgery. A further cranial CT scan revealed a hypodense parenchymal lesion involving the whole right frontal lobe, which was shown by magnetic resonance image as a heterogeneously enhanced and poorly circumscribed lesion extending into the mesial frontal and subcortical areas. Craniotomy was done to excise the lesion, and histopathology revealed glioblastoma multiforme (GBM). The patient then underwent temozolomide-based concurrent chemoradiotherapy. This is an unusual case of GBM with intratumoral hemorrhage masquerading as hypertensive lobar ICH, causing a diagnostic pitfall for spontaneous ICH. For stereotactic aspiration for atypical spontaneous ICH, targets should include the surrounding hypodense or edematous area.