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Glioblastoma Multiforme and Ascending Weakness

Published online by Cambridge University Press:  02 December 2014

L.J. Cooke ,
William Morrish  and
W.J. Becker
L.J. Cooke
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, AB, Canada
William Morrish
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, AB, Canada
W.J. Becker
Affiliation:
Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, AB, Canada
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An 18-year-old man with a known glioblastoma multiforme, previously treated with de-bulking, chemotherapy, radiation and steroids, underwent a repeat craniotomy after presenting with several days of intractable vomiting and headache. Postoperatively, he developed progressive delirium, bilateral sixth and seventh nerve palsies, dysphagia and ascending weakness of the upper and lower limbs. Within five postoperative days, he was quadraparetic, areflexic and had marked extraocular muscle and facial weakness, dysphagia, dysphonia and respiratory muscle weakness. The patient was started empirically on intravenous immunoglobulin for suspected Guillain-Barré syndrome (GBS). The following day, lumbar puncture demonstrated elevated protein (1.96g/l; normal <0.45), and a reduced glucose (0.5 mmol/l) and elevated red (4125x106 per litre) and white cell (214x106 per litre) counts in the cerebrospinal fluid (the red cells were felt to be related to surgery). The cell differential included 69% neutrophils, 3% lymphocytes, 15% monocytes and 13% blast-like cells. Gram stains and cultures of the cerebrospinal fluid were negative.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 29 , Issue 4 , November 2002 , pp. 372 - 374
Copyright
Copyright © The Canadian Journal of Neurological 2002

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