Presentation
Sudden onset headache and reduced level of consciousness.
Patient Data
A large heterogenous hemorrhagic mass in the left thalamus is present with marked non-communicating hydrocephalus.
A large left thalamic mass is present with heterogeneous enhancement and central non-enhancement. Hemorrhagic components result in blooming. Ventricles have reduced in size and a craniotomy is now present.
In a young patient in addition to a high grade glioma (GBM), which is the most likely diagnosis, one could entertain a pilocytic astrocytoma or less likely a metastases.
Case Discussion
The patient went on to have a biopsy and third ventriculostomy (between CT and MRI) which confirmed the diagnosis of glioblastoma multiforme (GBM).
Note: IDH mutation status is not provided in this case and according to the current (2016) WHO classification of CNS tumors, this tumor would, therefore, be designated as a glioblastoma NOS.