Snapshot A 63-year-old man is brought to the physician's office by his son due to progressively worsening headache and weakness. His headache began approximately 3 months prior to presentation and is described as diffuse but worse on the right-side of the head. The headache worsens with coughing and lifting heavy objects and is associated with nausea, multiple episodes of vomiting, and left-sided weakness. He previously worked for the synthetic rubber industry for over 30 years. Physical examination is significant for 3/5 strength in the left upper and lower extremity. Magnetic resonance imaging (MRI) of the head is shown. Introduction Clinical definition a highly malignant astrocytic brain tumor Epidemiology Incidence 3/100,000 in the United States the most common malignant primary brain tumor Demographics slightly more common in men Risk factors ionizing radiation exposures include synthetic rubber and petrolium production vinyl chloride or pesticides genetic disorders such as Turcot syndrome Li-Fraumeni syndrome Lynch syndrome Neurofibromatosis type 1 Cowden syndrome ETIOLOGY Pathogenesis tumor can contain neoplastic astrocytes that are poorly differentiated the tumor can result in a diffuse infiltrative growth pattern Presentation Symptoms headache features that are suggestive of a brain tumor in patients with headache include nausea and vomiting change in headache pattern abnormal neurologic exam worsening headache with changes in body position (e.g., bending over) and Valsalva maneuvers seizure cognitive change Physical exam focal neurologic deficit Imaging MRI indication this imaging modality is most commonly used when assessing for brain tumors modality gadolinium-enhancement findings ring-enhancing lesion with serpentine irregularity of the margins "butterfly" glioma Studies Histology confirms the diagnosis which is typically assessed after surgical resection histological findings include pleomorphic cells arranged in a "pseudopalisading" pattern around a central area of necrosis nuclear atypia invasive growth Differential Anaplastic astrocytoma Metastatic brain cancer Demyelination Treatment Medical temozolomide indication can be used as concurrent chemoradiotherapy for glioblastoma Surgical tumor resection indications to achieve maximal surgical resection while preserving neurologic function and allows for a histologic diagnosis adjuvant radiation therapy is standard therapy after resection Complications Survivors glioblastoma can result in cognitive deficits focal neurologic deficits personality changes apathy Prognosis This is typically a poor prognosis < 30% survival rate in 1 year