반복된 뇌실질 출혈로 진단이 늦어진 시상부 신경교모세포종

Delayed Diagnosis of Thalamic Glioblastoma Presenting as Repeated Intracerebral Hemorrhages

Although rare, neoplasms can be obstructed by intracerebral hemorrhage, delaying histological diagnosis and proper treatment. We report the case of a 30-year-old male presenting with serial intracerebral hemorrhages in the left thalamus. Stereotactic biopsy failed to make histologic diagnosis; open biopsy, two months after the initial hemorrhage, diagnosed glioblastoma. The characteristics of hemorrhage from glioblastoma drawn from our experience and a comprehensive review of the literature include the following: (1) under 14 years of age or old age (2) deep seated supratentorial or posterior fossa location (3) disproportionately diffuse brain edema (4) suspiciously enhancing mass lesion (5) irregular shape and heterogeneous appearance with solid areas of blood, multiple hemorrhage, and a ring-shaped hemorrhage. Direct proof of hemorrhagic origin is necessary for diagnosis and treatment of intracerebral hemorrhage with atypical location, imaging findings, or clinical course.