Differential Diagnostic Considerations in a Patient With New Onset Apathy: A Case Study on Frontal Lobe Glioblastoma Multiforme

Joy Zarandy, Sarah Yoon, Sharnikha Saravanan, Sanjana Das, Sarah Thomas

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This case study involves a 50 year-old previously healthy female presenting with a two-week history of clinically significant apathy. The patient and her family assume her symptoms are due to a potential underlying psychiatric condition; however, neurologic and systemic disorders should also be considered when evaluating a patient with sudden personality change. After a thorough history and physical exam, further evaluation with neuroimaging is performed due to suspicion of neurological etiology. A sizable ring-enhancing lesion in the frontal lobe is noted on MRI, and a diagnosis of glioblastoma multiforme (GBM) is confirmed with biopsy. GBM, or grade 4 astrocytoma, is an aggressive primary brain tumor with a poor prognosis. Neurological deficits can develop quickly over days to weeks, and may vary depending on tumor location. Most GBMs are located supratentorial, with the majority in the frontal or temporal lobes. Sudden personality or mood changes are highly indicative of GBM located in the frontal lobe due to its role in managing executive functions, such as initiating and focusing on tasks, emotional control, and organization. After maximal surgical resection of the tumor, radiation, and chemotherapy, a patient with GBM may prolong their survival from 3-months to 15-months; therefore prompt diagnosis and early initiation of treatment is imperative. Working with a highly skilled multidisciplinary care team is also important in coordinating an individualized treatment plan for patients with GBM.

Original languageAmerican English
JournalThe Journal of Integrated Primary Care
StatePublished - Dec 14 2023

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