Abstract
Objective We report a case of subacute ischaemic stroke mimicking glioblastoma multiforme (GBM) due to hypodysfibrinogenemia in a tertiary Australian hospital.
Results A 44-year-old woman presented with a one-week history of progressive headache, diplopia and vomiting. Bilateral papilloedema was noted on examination, without fever, confusion or other neurological deficits. A CT head showed a large area of hypoattenuation with associated vasogenic oedema in the right frontotemperoparietal region which demonstrated several areas of ring-enhancement on postcontrast imaging. MRI further characterised the lesion which had features of haemorrhage, diffusion restriction, vasogenic oedema and associated mass effect. GBM was proposed as the likely diagnosis in a tertiary neuroradiology meeting. A CT chest, abdomen and pelvis showed no metastasis, but did demonstrate small subsegmental pulmonary embolism. The lesion was resected, with histopathology showing cerebral infarction with haemorrhage and reactive gliosis, without malignancy. The patient’s symptoms improved post-operatively. Serum tests were largely unremarkable except for low fibrinogen level (1g/L) and low clottable fibrinogen (0.5g/L), indicating quantity and quality defects. Subsequent genetic testing confirmed congenital hypodysfibrinogenemia. Given no other causes were found in the post-operative stroke workup, her stroke was attributed to hypodysfibrinogenemia. She was prescribed lifelong aspirin with regular haematology follow-up.
Conclusion The presented case highlights that subacute stroke with haemorrhagic transformation can occasionally mimic GBM and should be considered on the differential diagnosis of GBM. Additionally, hypodysfibrinogemia is a rare cause of stroke seen in the presented patient and a coagulation profile should be routinely obtained for stroke workup.
