title: Extremely rare glioblastoma multiforme of the conus medullaris with holocord and brain stem metastases, leading to cranial nerve deficit and respiratory failure: a case report and review of the literature.
abstract: BACKGROUND
  Spinal glioblastoma multiforme (GBM) is an uncommon entity and metastases are extremely rare. Glioblastoma multiforme of the conus medullaris is a rare and highly aggressive entity that can quickly progress to a dismal state. Proper diagnosis via histopathologic and immunochemical staining with close clinical and radiological follow-up is important for the management of this very aggressive tumor.
  
  
  METHODS
  The authors report the clinical features, histopathologic and immunochemical staining characteristics, as well as the radiographic evidence of a case of primary GBM of the conus medullaris with metastases to the whole spinal cord and brain in a 20-year-old man who presented with low back pain and bilateral lower extremity weakness and numbness. Review of the pathology slides using histopathologic and immunochemical staining showed GBM. Serial magnetic resonance scans, performed after the initial surgery, demonstrated enlargement of the primary GBM in the conus medullaris with metastases to the thoracic and cervical spinal cord as well as to the brain.
  
  
  CONCLUSIONS
  Glioblastoma multiforme of the conus medullaris with such clinical findings is extremely rare. We analyze similar cases in the literature and discuss the importance of monitoring the progression of such an entity as well as the need for aggressive management of the different complications as they arise to maintain a good quality of life.
authors.affiliation: Division of Neurological Surgery, The Medical College of Ohio, Toledo, OH 43614-5807, USA. amedhkour@mco.edu
authors.forename: Azedine
authors.initials: A
authors.lastname: Medhkour
authors.forename: Michael
authors.initials: M
authors.lastname: Chan
mesh_terms: D000328:Adult; D001933:Brain Stem / Q000473:pathology / Q000503:physiopathology; D020295:Brain Stem Neoplasms / Q000150:complications / Q000556:secondary*; D003389:Cranial Nerve Diseases / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D017809:Fatal Outcome; D005904:Glial Fibrillary Acidic Protein / Q000378:metabolism; D005909:Glioblastoma / Q000150:complications / Q000556:secondary*; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D008297:Male; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000503:physiopathology; D010291:Paresis / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D035583:Rare Diseases; D012131:Respiratory Insufficiency / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D013116:Spinal Cord / Q000473:pathology / Q000503:physiopathology; D013117:Spinal Cord Compression / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D013120:Spinal Cord Neoplasms / Q000473:pathology* / Q000556:secondary* / Q000601:surgery
chemical_list: D005904:Glial Fibrillary Acidic Protein