Leptomeningeal glioblastoma presenting with multiple cranial neuropathies and confusion

Glioblastoma multiforme (GBM) is the commonest primary malignant neoplasm o f the CNS. Usually, patients present with seizures and headache but in the elderly, confusion and generalised cognitive decline are more frequently th e initial features. Multiple cranial nerve lesions as a manifestation of le ptomeningeal meningitis is a rare presentation of GEM. The diagnosis is not often suggestive on either brain computed tomography (CT) or magnetic reso nance imaging (MRI) and is usually confirmed by cerebrospinal fluid (CSF) c ytology or histology. We describe the case of an 80-year-old man, who prese nted with multiple cranial nerve palsies and confusion secondary to leptome ningeal gliomatosis, in whom GEM was detected along the intra-ventricular l ining of the left lateral ventricle at ventriculoscopy, in the absence of a distinct parenchymal lesion. (C) 2000 Elsevier Science B.V. All rights res erved.