Rare Case Report of Multicentric Glioblastoma Multiforme Initially Mimicking With Herpes Simplex Encephalitis on MRI and Its Progression on Serial Imaging

Abstract

We report a case of a 58-year-old man with multicentric glioblastoma initially presenting as acute encephalitic illness. He presented with seizures and cognitive impairment in the emergency department of our hospital. Initially clinical and brain MRI findings were in favor of herpes simplex virus (HSV) encephalitis. The patient had initially improved after medical treatment. After 3 months, the patient complained of recurrent seizures. A follow-up brain MRI revealed marked increase in size of lesions and surrounding perilesional edema in the bilateral frontal lobes, cingulate gyrus and left insular cortex on T2-weighted images and lesions showed enhancement on post-contrast T1-weighted images. Patient underwent right frontal craniotomy and resection of lesion in right frontal region. The treatment is surgery or palliative, and management is controversial. The prognosis, however, remains unfavorable. Therefore, in elderly patients presenting with multifocal lesions on MRI of brain or atypical encephalitic symptoms, the rare possibility of multicentric glioblastoma multiforme should be considered as differential diagnosis.




J Med Cases. 2016;7(2):70-76
doi: http://dx.doi.org/10.14740/jmc2401w