7.4 Headache attributed to intracranial neoplasia

Identification: Sex/Age: Male, 58 years Background: Controlled hypertension, smoking (30 pack-years) Family history: No history of neoplasms History of Present Illness (HPI): Main symptom: Progressive headache for 6 weeks Characteristics: Location: Right frontotemporal Character: Deep, continuous, non-pulsatile Intensity: 7/10, worse in the morning Aggravating factors: Cough, neck flexion, and Valsalva maneuver Relieving factors: No analgesic effective Associated symptoms: Occasional nausea Intermittent double vision (diplopia) Progressive recent memory loss Weakness in the left hemibody Physical/Neurological Examination: General: Preserved consciousness, temporal disorientation Neurological: Left brachio-crural paresis (4/5) Left extensor plantar reflex (Babinski +) Bilateral papilledema Right sixth cranial nerve palsy Complementary Exams: Magnetic Resonance Imaging of the Brain: Heterogeneous expansive lesion in the right frontal lobe (3.5 cm) with mass effect and perilesional edema Biopsy: Glioblastoma multiforme (WHO grade IV) Fundoscopy: Bilateral papilledema