Ischemic Stroke After Tumor Resection in a Patient With Glioblastoma Multiforme

Abstract

Glioblastoma multiforme (GM) is the most common type of aggressive malignant glioma in the brain or spinal cord and represents 15% of all primary brain tumors among adults. Although ischemic strokes in the setting of an underlying glioma is a rare occurrence, its diagnosis is usually challenging due to the overlapping neurological manifestations with the underlying brain tumor. We report a case of a 58-year-old white male who presented with subacute worsening symptoms of expressive aphasia with focal neurological symptoms, including right-sided extremity motor weakness and intermittent vision spots. Magnetic resonance imaging (MRI) of brain revealed a large 9.5 cm infiltrating mass in the left frontal and temporal lobes, strongly indicative of a primary glioma. The patient underwent resection to confirm diagnosis and remove part of the tumor mass. Pathological examination revealed GM. Expressive aphasia was markedly improved following the surgery; however, on postoperative day 3, the patient developed acute onset of right-sided weakness and sensory deficit. MRI revealed acute left posterior, frontal, and parietal infarct. Unfortunately, recent brain surgery would not allow for intravenous thrombolysis, and, therefore, he was discharged with a plan for outpatient radiation treatment and oral temozolomide chemotherapy.

Neurophysiotherapy in Grade II Diffuse Astrocytoma: A Case Report

“…In most cases, the surgical removal of these kinds of tumors is not possible [ 15 ]. Additionally, neurological impairment occurs in 30% of patients postoperatively due to the tumor's close proximity to the brain stem and enlarged and soft cranial nerves (edema) during tumor removal [ 16 ]. The resection should be as extensive as achievable.…”

Diffuse low-grade glioma misdiagnosed as acute cerebral infarction: A case report

“…[ 9 ] In this case, the patient’s medical history and lesion location were not in line with the above characteristics. Diffuse gliomas with IDH mutations feature a higher incidence of epilepsy, which is often an initial clinical symptom, and can also lead to manifestations of ischemic stroke [ 10 ] ; however, intracranial tumors are still absolute contraindications to intravenous thrombolysis because reperfusion injury is associated with a higher risk of symptomatic intracranial hemorrhage, and it cannot improve the neurological improvement rate and long-term survival benefits. [ 11 ] Most clinical evidences show that the use of intravenous thrombolysis and mechanical thrombectomy does not increase the risk of post–stroke epilepsy, and post-thrombolysis hemorrhagic transformation is an independent risk factor for post–stroke epilepsy or epilepsy.…”

Intracranial emergencies in neurosurgical oncology: pathophysiology and clinical management

“…Treatment complications from surgery and radiotherapy account for the majority of ischemic strokes in patients with primary brain tumors [72]. Radiation can induce vasculopathy, thereby accelerating endothelial injury and atherosclerosis, and causing a stroke [74]. The use of bevacizumab or other therapies blocking VEGF is associated with ischemic stroke and intracranial hemorrhage in patients with glioma [75,76].…”

“…Such strokes occur in the setting of prolonged therapy, while by contrast the majority of ICHs are asymptomatic, intra-tumoral, and occur in the context of tumor progression [76]. Spontaneous ischemic infarcts are a rare occurrence in patients with glioma with few cases reported in the literature [74,77,78]. More commonly such occlusive strokes occur after interruption of a critical artery during tumor resection, with neurologic sequelae evident when the patient awakens from anesthesia.…”