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Glioblastoma multiforme: a devastating diagnosis
  1. Matthew R B Evans1,
  2. Stephen B Evans2
  1. 1MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, London, UK
  2. 2Lyell McEwen Hospital, Elizabeth Vale, South Australia, Australia
  1. Correspondence to Dr Matthew R B Evans, MRC Centre for Neuromuscular Diseases, UCL Institute of Neurology, 8-11 Queen Square, London WC1N 3BG, UK; matthew.evans{at}ucl.ac.uk

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It declared itself abruptly with bright flashing lights in the left visual hemifield. Our 71-year-old left-handed dad (figure 1), a general practitioner and master handyman, had been painting the ceiling, his neck in forced extension. Thinking that the rapid flashing (approximately twice his pulse rate) may relate to his neck position, he lay down hoping it would pass. Fortunately, he answered his mobile when mum rang, but could say just a few words: “So”, “OK”, “I think”; repeating them over and over. He appeared vague and was aphasic, but could walk downstairs. The seizure then generalised when in the ambulance.

Figure 1

Dad in white. The importance of family support in a crisis such as this cannot be overemphasised. Image published with permission.

His scan showed a solitary right parieto-occipital, primary high-grade tumour (figure 2A–D). Our world collapsed. Surgery was scheduled for 7 days later, giving dad time to sort out his affairs. He promptly retired from general practice, having done several home visits on the day before admission. He was courageously practical: “I'm grateful it's a tumour rather than a stroke. At least this way I have a period of grace”.

Figure 2

MRI brain. Axial T2w (A and B), axial (C) and sagittal (D) post-contrast T1w images on admission; and axial T2w (E and F), sagittal T1w (G) and post-contrast T1w (H) images after 12 weeks. MRI head on admission (A–D) shows a heterogenous, peripherally enhancing right occipital lobe mass with central necrosis, situated adjacent to the parieto-occipital sulcus. Enhancing component measures 3.7×1.7 cm. There is non-enhancing signal change, likely tumour (red arrow) at the trigone of the lateral ventricle and involving the tail of the hippocampus with mild associated swelling (blue arrow). MRI head after 12 weeks (E–H) shows evidence of surgery (red bracket). There is a larger lesion (4.3×2 cm), now extending into the …

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