Ischemic Stroke After Tumor Resection In A Patient With Glioblastoma Multiforme

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.