title: Glioblastoma complicated by fatal malignant acute ischemic stroke: MRI finding to assist in tricky surgical decision.
abstract: BACKGROUND
  In most cases, glioblastomas are associated with seizures, headaches, neurological deficits, aphasia, or bleeding. But these tumors are rarely associated with cerebral infarction and never so deadly.
  
  
  METHODS
  A 40-year-old man presented with sudden morning isolated aphasia. One hour later, he developed a motor deficit at right upper member, quickly completed with a total right hemiplegia. Imaging studies revealed a left frontotemporal enhancing glioblastoma with a perilesional edema which produced an important mass effect on the posterior arm of the external capsule, on the primary motor cortex posteriorly and the entire sylvian valley anteriorly. Due to major surgical risks associated with left middle cerebral artery (MCA) inclusion and large edema, we decided to postpone the tumor removal and introduce quickly high concentrations of steroids. Twenty-four hours after his admittance, the patient presented a sudden impaired consciousness, coma, and a left mydriasis. A brain magnetic resonance image (MRI) revealed a left malignant MCA infarction, deadly for the patient.
  
  
  CONCLUSIONS
  To our knowledge, glioblastomas complicated by fatal ischemic stroke have not been reported. We discuss the pathology of such an event and try to figure out if it was predictable based on MRI finding, and inevitable with precocious surgery.
authors: Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France aymmed@hotmail.fr.
authors: Aymeric
authors: A
authors: Amelot
authors: Stroke Unit, Hôpital La Pitié Salpétrière, APHP, Paris, France.
authors: Flore
authors: F
authors: Baronnet-Chauvet
authors: Department of Radiology, Hôpital European Georges Pompidou, APHP, Paris, France.
authors: Edith
authors: E
authors: Fioretti
authors: Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France.
authors: Bertrand
authors: B
authors: Mathon
authors: Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France.
authors: Philippe
authors: P
authors: Cornu
authors: Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France.
authors: Aurélien
authors: A
authors: Nouet
authors: Department of Neurosurgery, Hôpital La Pitié Salpétrière, APHP, Paris, France.
authors: Dorian
authors: D
authors: Chauvet
mesh_terms: D000328:Adult; D001932:Brain Neoplasms / Q000150:complications*; D003657:Decision Making; D017809:Fatal Outcome; D005909:Glioblastoma / Q000150:complications*; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology*; D008279:Magnetic Resonance Imaging; D008297:Male; D020521:Stroke / Q000209:etiology*
keywords: MRI diagnostic; acute ischemic stroke; glioblastoma