Artikel
Case report: 3 recent cases of glioblastoma revealed by intracerebral haemorrhage
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Autoren
Veröffentlicht: | 4. Mai 2005 |
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Gliederung
Text
Objective
Glioblastoma revealed by spontaneous intracerebral haemorrhage is rare (4%). We report 3 recent clinical cases of glioblastoma revealed during surgery for intracerebral haematoma.We would particularly like to stress the need for rapid diagnosis.
Methods
Our 3 recent cases were all males aged 39, 47 and 69. Onset was acute with cephalea, vomiting, confusion and appearance within a few minutes of the neurological disorders. Diagnosis was made following CT scan which showed a voluminous intracerebral hematoma followed by emergency surgery. Following surgery and histological results, treatment consisted of chemotherapy, radiotherapy and CT/MRI monitoring.
Results
These 3 cases each presented a malignant tumour revealed by intracerebral haemorrhage. Histological examination of the clots confirmed the diagnosis of glioblastoma. At the time of the initial examination, 2 of the patients presented coma (GCS: 7-8) with neurological deficit. The third presented a GCS of 12 and intracranial hypertension. The initial CT scan revealed an intracerebral hematoma in all 3 cases (1 case left temporal hematoma, 2 cases right temporo-parietal hematoma) with significant mass effect. The initial diagnosis was spontaneous intracerebral haemorrhage with increased HTA in 1 case. All 3 patients were submitted to emergency surgical treatment. In 2 cases, macroscopic gross-total excision was possible. One case was operated for spontaneous intracerebral haematoma and 15 days later for malignant tumour after a second haemorragic accident. The post-operative volution was favourable in the first weeks: 1 case recovered motivity entirely and 1 case had minimum side effects. The third patient presented hemiplegy after the second procedure. There was tumour recurrence after 13 weeks in 1 patient who refused all complementary treatment and after 17 weeks in another patient who was treated by radio and chemotherapy. The last case is currently undergoing a course of chemotherapy 6 months after surgery. Two patients died, the first 9 months after the initial haemorrhage and the other after 21 months.
Conclusions
Glioblastoma revealed by intracerebral haemorrhage is rare. It is difficult to preoperatively detect a tumoral lesion in an emergency situation. In patients presenting intracerebral haemorrhage, it is important to perform a histological exam of the tissue surrounding the clot and to withdraw the clot in order detect a possible glioblastoma in the form of a cerebral haemorrhage.