Spot diagnosis

摘要

An 8-year-old girl was brought to the emergency department by her parents after she had a 10-minute episode of incomprehensible speech and blank staring, as well as a 30-second "collapse" associated with a generalized tonic-clonic seizure. On arousal, she vomited and appeared confused. Her parents reported that she did not have a history of seizures, but they described several episodes of staring "blankly" in the preceding weeks, and she had reported severe headaches. On arrival at the emergency department, she was alert and afebrile, with no signs of meningism; however, a persistent Todd's (postictal) paresis was noted. Magnetic resonance imaging of the brain showed a space-occupying lesion in the left superior temporal gyrus, measuring 4.2x3.9x3.1 cm, which was causing mass effect over the sylvian fissure and ipsilateral lateral ventricle (Fig. 1A). Neurosurgical resection of the lesion confirmed the diagnosis of glioblastoma multiforme (World Health Organization grade IV) on histologic examination.