Atypical Presentation of a Hemorrhagic Glioblastoma Multiforme Mimicking a Cerebral Contusion

The emergency room management of a patient with external signs of cranial trauma and imaging showing brain hemorrhage can be dangerously misleading. This case of a patient with glioblastoma could only be timely diagnosed because of cautious evaluation of imaging findings. A 60-year-old patient presented to the emergency room after being found down with external signs of cranial trauma and a reduced level of consciousness. Computed tomography revealed a right frontal polar cortical hemorrhage of around 12 mm diameter with no perilesional edema or contrast enhancement. Likewise, the MRI showed no contrast enhancement. Before the scheduled MRI follow-up was performed the patient became symptomatic leading to an earlier repeat that showed massive progression. She underwent surgical resection that revealed the lesion to be an aggressive glioblastoma. High suspicion of an underlying neoplastic lesion in atypical brain hemorrhage in trauma patients is paramount. Short MRI follow-up is recommended as soon as the hematoma resorbs to prevent delays with potential impact or patient outcome.