Delirium and topographical disorientation associated with glioblastoma multiforme tumour progression into the isthmus of the cingulate gyrus

• Published in: BMJ case reports Vol. 2018; p. bcr-2018-225473
• Main Authors: Zervos, Thomas M, Robin, Adam M, Lee, Ian
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 17-08-2018; BMJ Publishing Group
• Series: Case Report
• Subjects: Ablation; Aged; Brain cancer; Brain Neoplasms - diagnosis; Brain Neoplasms - diagnostic imaging; Brain Neoplasms - pathology; Brain Neoplasms - surgery; Case reports; Consent; Delirium; Delirium - etiology; Diagnosis, Differential; Disease Progression; Edema; Family medical history; Fatal Outcome; Findings That Shed New Light on the Possible Pathogenesis of a Disease or an Adverse Effect; Glioblastoma - diagnosis; Glioblastoma - diagnostic imaging; Glioblastoma - secondary; Glioblastoma - surgery; Gyrus Cinguli - diagnostic imaging; Humans; Lasers; Magnetic Resonance Imaging; Male; Neurosurgery; Patients; Radiation therapy; Seizures - etiology; West Nile virus; United States > US; Minnesota; neurosurgery; cancer intervention; delirium
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2018-225473

Since there is no cure for glioblastoma multiforme (GBM), the goal of treatment becomes prolonging the survival through cytoreduction while minimising neurological deficits. In this case report, laser interstitial thermal therapy (LITT) was used once the tumour progressed into the isthmus of the cingulate gyrus. One year after temporal lobectomy, disorders of memory, emotion, personality and navigation, likely related to limbic system involvement along with hallucinations and fluctuating cognition occurred as the tumour progressed. After ablation of the posterior cingulum, worsening of topographical disorientation was observed.Per literature review, delirium has been noted in patients with strokes involving the right-sided temporo-parieto-occipital junction, and topographical disorientation has been associated with lesions of the right posterior cingulum. Alternative causes of these deficits were ruled out, leaving structural changes as the primary explanation. This is the first report of the neurological deficits associated with tumour progression and vasogenic oedema in this region.