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Glioblastoma NOS

Case contributed by Subash Thapa
Diagnosis almost certain


Sudden onset of right side weakness and slurred speech. No history of seizure, loss of consciousness or trauma.

Patient Data

Age: 70 years
Gender: Male

 ASNR 2016: This case was submitted as part of the American Society of Neuroradiology (ASNR 2016) Case Of The Day competition, in collaboration with 


There is an ill-defined expansile supratentorial mass measuring approx. 3.7 x 3.6 cm in the left temporal region appearing hypointense on T1W image, intermediate to high signal with few hypointense signals within on FLAIR and T2W images.

On post-contrast T1W image, there are multiple confluent irregular ring-enhancing lesions of various sizes involving region involving left periventricular white matter, left lentiform nucleus and left thalamus with peri-lesional edema. DWI shows restriction. There is mass effect as evidenced by the effacement of left lateral ventricle.


MR spectroscopy at the lesion shows elevated choline (3.2 ppm) and decreased NAA (2.02 ppm) with choline to creatine ratio of 2.6.

There is increased choline at 3.2 ppm and decreased NAA at 2.02 ppm in the perilesional edema s/o peritumoral spread.

Case Discussion

Stereotactic biopsy was done. Histopathology revealed: Glioblastoma, WHO grade IV.

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

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