September 2017

56-year-old with speech difficulty


A 56-year-old female presents with one week of worsening memory, trouble finding words and using the wrong words intermittently. Her family also feels she is withdrawn. She is a non smoker and has no history of cancer. No serious medical problems.


Awake, alert, able to name normally, trouble with repetition and occasionally uses inappropriate word, paucity of spontaneous speech
Cranial nerves II-XII are intact
Strength- 5/5 upper extremities
No sensory loss
DTR wnl Cerebellar function and gait are normal

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1. What MR imaging finding can be useful to distinguish between lymphoma and glioblastoma?
2.What neurologic function would be at risk from surgical resection?
3. After surgery a diagnosis of GBM is confirmed. The patient is offered standard medical therapy. In addition to radiation and temozolomide this now includes:
4. Which of the following describes you?
5. I practice in one of the following locations.

I would like to continue chemotherapeutic agents such as temodale, PCV, or CCNU rather than Tumor treating fields or Bevacizumab. Also I treat dendrite cell therapy in some cases.

Thank you

Gliadel wafer still has a role for the treatment of GBM.

Very good case

Radical removal with navigation and possibly use of wafers.


Poor prognosis

Really helpful

Please subit your answers to see the case explanation.


  • Stupp et al. Maintenance Therapy With Tumor-Treating Fields Plus Temozolomide vs Temozolomide Alone for Glioblastoma: A Randomized Clinical Trial. JAMA 2015.
  • Chinot et al. Bevacizumab plus radiotherapy-temozolomide for newly diagnosed glioblastoma. NEJM, 2014.
  • Gilbert et al. A randomized trial of bevacizumab for newly diagnosed glioblastoma. NEJM, 2014.

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