Tingling, Numbness, and Underlying Malignancy: A Case Report of Glioblastoma Multiforme

Glioblastoma multiforme (GBM) is a World Health Organisation (WHO) grade IV glioma originating from astrocytes. It is the most common malignant primary tumour of the brain and central nervous system (CNS) and is associated with fast progression and violent local spread, with a median overall survival of approximately 15 months after diagnosis. Due to its late and varied presentation, it is often diagnosed only after it has grown considerably. The symptomatology can vary from the individual being completely asymptomatic to mild sensory or sensorimotor symptoms. The symptoms usually arise due to compression of the fibres rather than pressure on vital structures.  We discuss a case of a 72-year-old male who presented with complaints of tingling in the left upper limb for one day, improving spontaneously. A noncontrast CT head was nondiagnostic, and an MRI reported a likely metastatic lesion, and further imaging was advised. A detailed history was taken from an oncology point of view but the patient denied any weight loss, fever, recent travel, and family history of cancers. The scans were discussed at a neuroradiology multidisciplinary team (MDT) discussion an MRI with contrast was planned. After a thorough discussion and further review by neuroradiology consultants, the patient was diagnosed with a grade IV glioblastoma - a primary tumour of the brain - which was confirmed by a biopsy and immunohistochemistry. He was treated with two cycles of radiotherapy initially, followed by chemotherapy. Unfortunately, he died eight months after the start of the treatment due to a massive pulmonary embolism, complicated by nosocomial infection. This report highlights the importance of early diagnosis and treatment for patients with glioma. It also sheds light on the symptomatology and difficulties faced in the diagnosis of gliomas. Treating physicians should adopt an MDT approach in such cases and discuss the various possibilities and differentials.