Atrial Bigeminy, a Potential Diagnostic Clue for Glioblastoma

Glioblastoma represents the most common and aggressive primary malignant central nervous system tumor, often manifesting with unusual signs. This case report highlights a patient diagnosed with glioblastoma following an unusual cardiac presentation, with syncopes, sinus bradycardia, and atrial bigeminy. A 51-year-old female, brought to the emergency room after experiencing repeated syncope episodes, displayed neurological deficits upon examination. Noteworthy, she presented abnormal ECG showing sinus bradycardia and atrial bigeminy. Following the diagnostic procedure, a tumor was identified with indication to surgical removal. A subtotal tumor resection was obtained and the morphopathology examination led to a glioblastoma diagnosis. Interestingly, post-operatively, the ECG was completely normalized. However, the patient experienced complications, consisting of a massive thromboembolism. While sporadic cases describe unusual glioblastoma manifestations, this report is unique in showcasing atrial bigeminy, among other ECG manifestation. The remission of atrial bigeminy post-operatively suggests its association with the glioblastoma. Tumor localization in the basal ganglia is crucial in understanding such manifestations. Idiopathic cardiac manifestations should not be disregarded, holding potential relevance in central nervous system etiology considerations.