Glioblastoma is the most common and most aggressive primary brain tumor in adults, growing fast and spreading into nearby brain tissue. It causes symptoms through pressure and swelling in the skull and through damage to the brain areas it invades.
Key symptoms
- New or worsening headache, often worse in the morning
- Seizures in an adult with no prior history
- Personality change, confusion or memory problems
- Weakness, numbness or speech trouble that builds over weeks
- Nausea and vomiting from raised pressure in the skull
What you find on exam
- Full neurological exam for focal weakness, sensory loss or speech deficits
- Cranial nerves and visual fields
- Fundoscopy for papilledema
- Mental status and level of consciousness
Tests
- MRI brain with contrast: ring-enhancing mass with swelling around it
- CT head if MRI is not available or the patient is unstable
- Biopsy or surgical removal to confirm the diagnosis and molecular markers
- Baseline blood count, metabolic panel and coagulation before surgery
Treatment basics
- Dexamethasone to reduce brain swelling
- Antiseizure medicine such as levetiracetam if seizures occur
- Maximal safe surgical removal
- Radiation with temozolomide chemotherapy after surgery
- Early palliative care and goals of care discussions
Red flags
- Drowsiness, confusion or a falling level of consciousness
- New seizure or seizure that does not stop
- Sudden severe headache with vomiting or a new focal deficit
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.