Glioblastoma Case Study Essay
Brad is a 37 year old Caucasian male that entered the Emergency Department after experiencing a seizure in the middle of the night. The seizure was described by his wife as generalized, lasting approximately two minutes with tonic-clonic movements along with a loss of unconsciousness and function of his bladder. Brad reported that he has had headaches that have been unresponsive to over the counter medication over the last four month and his wife also notes that he has had an increased loss in energy and interest in normal pleasurable activities. Based off of the symptoms, his physical examination results and laboratory tests, I have diagnosed Brad with Glioblastoma multiforme, which is also known as grade IV astrocytoma. Brad appears to
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have some of the top symptoms associated with Glioblastoma multiforme which consists of headaches, personality changes and seizures. Headaches are often an early, nonspecific clinical sign that occur, because of an increased pressure in the brain, which are usually worse in the morning. In Brad’s initial history he complains of having headaches for the last four months and reports that they are often worse in the morning. During the physical examination, Brad also complains of a current dull, diffused headache rated a 4 out of 10 on a normal pain scale. Another common symptom of Glioblastoma multiforme consists of changes in personality, mood and ability to concentrate due to damage of the frontal lobe, which could be connected to Brad’s past medical history of severe depression. This includes he’s loss of interest in normally pleasurable activities and loss of energy. Seizures are also often a common symptom of Glioblastoma multiforme and loss of consciousness is often a frequent symptom in the final weeks of a patient with a brain tumor. As the brain tumor grows, it can create pressure against damaged nerves or other structures that can affect the brain’s ability to function normally and can interfere with thought, memory, emotion, movement, vision, hearing and touch. During the physical examination Brad is uncooperative when assessing the strength of his lower extremities, has extremely unsteady gait and can only stand with bilateral support. He is unable to walk more than two steps, which is related to muscular and motor weakness, a symptom of Glioblastoma. His lab results also show that he has a high magnesium level and a low vitamin B12 level, which are often associated with muscle weakness especially in the lower exterminates that can cause difficulty walking. When assessing his abdomen, it is reported that Brad has a rounded abdomen from excessive fluid and prominent hepatomegaly, which is an enlarged liver. Recent studies have found that Glioblastoma multiforme is related to causing the brain to produce hepatocyte growth factor, which stimulates liver cell growth. The enlarged liver also connects to his low level of albumin and high level of bilirubin in this blood test. During the neurologic section of the assessment, Brad scored a 12 out 30 on the mini mental status exam. This test is designed to measure cognitive impairment and to estimate the severity and progression of the cognitive impairment. His results placed him in the category that labels him severely cognitively impaired, which is related to damaged nerves in the brain from the tumor. His optic discs tested positive for bilateral papilledema, which are caused by optic disc swelling. This occurs from an increase in intracranial pressure caused from the tumor in the frontal lobe. Brad also tested positive for nystagmus, which is involuntary movement of the eyes, which are listed as a common symptom in brain tumors. After detecting the tumor in the MRI scan and obtaining the results from the biopsy, I was able to assign a name to the tumor and grade by discovering what type of brain cell the tumor came from and by finding the specific genetic mutations within the tumor. The CT scan reports a large mass in both frontal lobes crossing the corpus callosum, which explains why Brad’s thought, memory, emotion, movement, and vision were abnormal. Glioblastoma usually consists of a large heterogenous mass in the supratentorial white matter. It is predominantly found in the frontal and cerebral hemispheres and 50 percent of glioblastomas cross the corpus callosum to affect more than one lobe at a time, making it bilateral. The results of the brain biopsy gross specimen showed a cellular proliferation of pleomorphic astrocytes with interspersed zones of necrosis, but lacked a surrounding pseudopalisade of neoplastic nuclei. The cell of origin of Glioblastoma is a mature astrocyte, which helped me further confirm that Brad has grade IV astrocytoma, which is also twice as likely to occur in men than women. The exact cause of astrocytoma is unknown, but research and studies that have been done over the years suggested different theories of the pathophysiology behind Glioblastoma multiform.
Researchers speculate that genetic and immunologic abnormalities, diet, stress, and environmental factors, such as exposure to ultraviolet rays, certain chemicals, and ionizing radiation may be linked with causing astrocytoma. Astrocytoma are derived from connective tissue cells called astrocytes. Astrocytes are responsible for protecting other nerve cells found within the brain and spinal cord and are known as glial cells and form tissue which is known as glial tissue. Tumors that arise from glial tissue, including astrocytomas, are collectively referred to as gliomas. They accounts for 35 to 50 percent of all tumors that are present in the brain and spinal cord. Astrocytoma is separated into two classification systems and into four different groups, which are determined by the histopathologic features, atypia, cellular density, mitotic activity, microvascular proliferation, and necrosis. Grades I and II usually grow slowly and are benign, while grades III and IV are typically malignant tumors. I believe Brad has Glioblastoma multiforme (GBM), which is characterized as a highly invasive, grade IV malignant
tumor. Grade IV astrocytoma is typically found in the frontal and cerebral lobes, but can also be found in the brainstem, cerebellum, and spinal cord. Scientist believe these tumors develop when cells lose normal growth restraints, which cause them to multiply uncontrollably. The basic cellular pathophysiology of GBM is epidermal growth factors activate epidermal growth factor receptors (EGFR) that alter their phenotype due to an overexpression, amplification or a mutation. 97 percent of all cases of GBM are from EGFR amplification, which is caused by reverse transcription or an insertion of a ribonucleotide base and is accompanied by overexpression. EGFR stimulates glioma cells, which leads to the activation of vascular endothelial growth factor (VEGF), which increase the sections of bioactive VEGF by 25 to 125 percent. The increase of VEGT is believed to account for increasing the tumor size. The tumor will continue to spread across the corpus callosum and the lesion will become bilaterally symmetric, resulting in a "butterfly" shape when imaged. The increase in growth of the tumor results in making several of the symptoms of GBM more severe, because there is an increase of pressure against the skull. Increased pressure within the brain may be caused by the tumor invading the surrounding tissue or by the blockage of ventricles, which results in the abnormal accumulation of cerebrospinal fluid in the brain. This results in an increase in intracranial pressure, which causes several of the symptoms Brad is having such as his depression, headaches, seizures, visual changes, confusion, gait disturbances and motor control problems. These symptoms are all function that are controlled in the frontal lobe, but the brain is unable to function normally due to the increased pressure against damaged nerves or other structures that interfere with thought, memory, emotion, movement, vision, hearing and touch.
Brad’s positive results for bilateral papilledema is a result from the optic disc swelling, which is also caused by the increased cranial pressure. His positive results for nystagmus is a result from semicircular canals being stimulated by astrocytoma while the head is not in motion. Glioblastoma multiforme has also been connected to producing large amounts of of hepatocyte growth factor which stimulates liver growth. The exact factors of the physiological process of this connection is unknown, but many researchers believe there is a causal relationship between the brain tumor and the hepatomegaly. This information connects to why Brad has a prominent hepatomegaly. This low levels of albumin and high level of total bilirubin are also connected to his enlarged liver, because low levels of albumin, which is a protein produced in the liver, indicate poor liver function. “Albumin comprises 75-80% of normal plasma colloid oncotic pressure and 50% of protein content. When plasma proteins, especially albumin, no longer sustain sufficient colloid osmotic pressure to counterbalance hydrostatic pressure, edema develops.” The build up of edema is why Brad’s abdomen appears rounded. Albumin is also responsible for transports various substances, including bilirubin, fatty acids, metals, ions, hormones, and exogenous drugs. The liver also produces bile, which contains bilirubin, which helps the breakdown of hemoglobin. After connecting all of Brad’s examination, symptoms and lab results I believe it is clear that Brad has Glioblastoma multiforme. Glioblastoma can be difficult to treat because the tumors contain so many different types of cells, but I would discuss the possibilities of surgery, radiation and chemotherapy.
have some of the top symptoms associated with Glioblastoma multiforme which consists of headaches, personality changes and seizures. Headaches are often an early, nonspecific clinical sign that occur, because of an increased pressure in the brain, which are usually worse in the morning. In Brad’s initial history he complains of having headaches for the last four months and reports that they are often worse in the morning. During the physical examination, Brad also complains of a current dull, diffused headache rated a 4 out of 10 on a normal pain scale. Another common symptom of Glioblastoma multiforme consists of changes in personality, mood and ability to concentrate due to damage of the frontal lobe, which could be connected to Brad’s past medical history of severe depression. This includes he’s loss of interest in normally pleasurable activities and loss of energy. Seizures are also often a common symptom of Glioblastoma multiforme and loss of consciousness is often a frequent symptom in the final weeks of a patient with a brain tumor. As the brain tumor grows, it can create pressure against damaged nerves or other structures that can affect the brain’s ability to function normally and can interfere with thought, memory, emotion, movement, vision, hearing and touch. During the physical examination Brad is uncooperative when assessing the strength of his lower extremities, has extremely unsteady gait and can only stand with bilateral support. He is unable to walk more than two steps, which is related to muscular and motor weakness, a symptom of Glioblastoma. His lab results also show that he has a high magnesium level and a low vitamin B12 level, which are often associated with muscle weakness especially in the lower exterminates that can cause difficulty walking. When assessing his abdomen, it is reported that Brad has a rounded abdomen from excessive fluid and prominent hepatomegaly, which is an enlarged liver. Recent studies have found that Glioblastoma multiforme is related to causing the brain to produce hepatocyte growth factor, which stimulates liver cell growth. The enlarged liver also connects to his low level of albumin and high level of bilirubin in this blood test. During the neurologic section of the assessment, Brad scored a 12 out 30 on the mini mental status exam. This test is designed to measure cognitive impairment and to estimate the severity and progression of the cognitive impairment. His results placed him in the category that labels him severely cognitively impaired, which is related to damaged nerves in the brain from the tumor. His optic discs tested positive for bilateral papilledema, which are caused by optic disc swelling. This occurs from an increase in intracranial pressure caused from the tumor in the frontal lobe. Brad also tested positive for nystagmus, which is involuntary movement of the eyes, which are listed as a common symptom in brain tumors. After detecting the tumor in the MRI scan and obtaining the results from the biopsy, I was able to assign a name to the tumor and grade by discovering what type of brain cell the tumor came from and by finding the specific genetic mutations within the tumor. The CT scan reports a large mass in both frontal lobes crossing the corpus callosum, which explains why Brad’s thought, memory, emotion, movement, and vision were abnormal. Glioblastoma usually consists of a large heterogenous mass in the supratentorial white matter. It is predominantly found in the frontal and cerebral hemispheres and 50 percent of glioblastomas cross the corpus callosum to affect more than one lobe at a time, making it bilateral. The results of the brain biopsy gross specimen showed a cellular proliferation of pleomorphic astrocytes with interspersed zones of necrosis, but lacked a surrounding pseudopalisade of neoplastic nuclei. The cell of origin of Glioblastoma is a mature astrocyte, which helped me further confirm that Brad has grade IV astrocytoma, which is also twice as likely to occur in men than women. The exact cause of astrocytoma is unknown, but research and studies that have been done over the years suggested different theories of the pathophysiology behind Glioblastoma multiform.
Researchers speculate that genetic and immunologic abnormalities, diet, stress, and environmental factors, such as exposure to ultraviolet rays, certain chemicals, and ionizing radiation may be linked with causing astrocytoma. Astrocytoma are derived from connective tissue cells called astrocytes. Astrocytes are responsible for protecting other nerve cells found within the brain and spinal cord and are known as glial cells and form tissue which is known as glial tissue. Tumors that arise from glial tissue, including astrocytomas, are collectively referred to as gliomas. They accounts for 35 to 50 percent of all tumors that are present in the brain and spinal cord. Astrocytoma is separated into two classification systems and into four different groups, which are determined by the histopathologic features, atypia, cellular density, mitotic activity, microvascular proliferation, and necrosis. Grades I and II usually grow slowly and are benign, while grades III and IV are typically malignant tumors. I believe Brad has Glioblastoma multiforme (GBM), which is characterized as a highly invasive, grade IV malignant
tumor. Grade IV astrocytoma is typically found in the frontal and cerebral lobes, but can also be found in the brainstem, cerebellum, and spinal cord. Scientist believe these tumors develop when cells lose normal growth restraints, which cause them to multiply uncontrollably. The basic cellular pathophysiology of GBM is epidermal growth factors activate epidermal growth factor receptors (EGFR) that alter their phenotype due to an overexpression, amplification or a mutation. 97 percent of all cases of GBM are from EGFR amplification, which is caused by reverse transcription or an insertion of a ribonucleotide base and is accompanied by overexpression. EGFR stimulates glioma cells, which leads to the activation of vascular endothelial growth factor (VEGF), which increase the sections of bioactive VEGF by 25 to 125 percent. The increase of VEGT is believed to account for increasing the tumor size. The tumor will continue to spread across the corpus callosum and the lesion will become bilaterally symmetric, resulting in a "butterfly" shape when imaged. The increase in growth of the tumor results in making several of the symptoms of GBM more severe, because there is an increase of pressure against the skull. Increased pressure within the brain may be caused by the tumor invading the surrounding tissue or by the blockage of ventricles, which results in the abnormal accumulation of cerebrospinal fluid in the brain. This results in an increase in intracranial pressure, which causes several of the symptoms Brad is having such as his depression, headaches, seizures, visual changes, confusion, gait disturbances and motor control problems. These symptoms are all function that are controlled in the frontal lobe, but the brain is unable to function normally due to the increased pressure against damaged nerves or other structures that interfere with thought, memory, emotion, movement, vision, hearing and touch.
Brad’s positive results for bilateral papilledema is a result from the optic disc swelling, which is also caused by the increased cranial pressure. His positive results for nystagmus is a result from semicircular canals being stimulated by astrocytoma while the head is not in motion. Glioblastoma multiforme has also been connected to producing large amounts of of hepatocyte growth factor which stimulates liver growth. The exact factors of the physiological process of this connection is unknown, but many researchers believe there is a causal relationship between the brain tumor and the hepatomegaly. This information connects to why Brad has a prominent hepatomegaly. This low levels of albumin and high level of total bilirubin are also connected to his enlarged liver, because low levels of albumin, which is a protein produced in the liver, indicate poor liver function. “Albumin comprises 75-80% of normal plasma colloid oncotic pressure and 50% of protein content. When plasma proteins, especially albumin, no longer sustain sufficient colloid osmotic pressure to counterbalance hydrostatic pressure, edema develops.” The build up of edema is why Brad’s abdomen appears rounded. Albumin is also responsible for transports various substances, including bilirubin, fatty acids, metals, ions, hormones, and exogenous drugs. The liver also produces bile, which contains bilirubin, which helps the breakdown of hemoglobin. After connecting all of Brad’s examination, symptoms and lab results I believe it is clear that Brad has Glioblastoma multiforme. Glioblastoma can be difficult to treat because the tumors contain so many different types of cells, but I would discuss the possibilities of surgery, radiation and chemotherapy.