Journal of IMAB - Annual Proceeding (Scientific Papers)
Publisher: Peytchinski, Gospodin Iliev
ISSN: 1312 773X (Online)
Issue: 2015, vol. 21, issue 4
Subject Area: Medicine - Neurology
Pages: 908-913

Published online: 13 November 2015

J of IMAB 2015 Oct-Dec;21(4):908-913
Ivan N. Dimitrov1Corresponding Autor, Ara G. Kaprelyan2, Radoslav Georgiev3, Borislav D. Ivanov4, Yavor Enchev5, Тony Avramov5, Margarita V. Grudkova2, Nadezhda S. Deleva2,
1) Department of Nursing, Sliven Affiliate, Medical University - Varna, Bulgaria
2) Department of Neurology, Medical University - Varna, Bulgaria
3) Department of Imaging Diagnostics and Radiotherapy, Medical University - Varna, Bulgaria
4) Department of Clinical Medical Sciences, Faculty of Dental Medicine, Medical University - Varna, Bulgaria
5) Department of Neurosurgery and Otolaryngology, Medical University - Varna, Bulgaria.

Background: The clinical features of multiple sclerosis during a relapse may raise the suspicion of a brain tumor as a possible differential diagnosis. Regardless of the high informative value of neuroimaging, some clinical cases remain challenging for neurologists, neurosurgeons and radiologists. Associations of brain tumors and relapsing-remitting multiple sclerosis have been described in the literature. Epilepsy, being common in brain tumors, is not among the most frequent and typical manifestations of multiple sclerosis, but both disorders appear together more commonly than by chance.
Objective: To present and discuss the diagnostic challenges in a case of coexisting epilepsy, multiple sclerosis, and glioblastoma multiforme.
Method: Case report.
Results: We present a 38-year-old patient with relapsing-remitting multiple sclerosis manifesting clinically a long period after a successfully treated epilepsy in childhood and adolescence. After reappearance of generalized tonic-clonic seizures and imaging evidence of a tumefactive lesion, the differential diagnosis between a new relapse and an initial manifestation of a brain was discussed. Glioblastoma multiforme was found intraoperatively.
Conclusion: Our case study demonstrates that the likelihood of parallel development of different pathological processes, such as demyelinating and neoplastic, in the same patient, should not be underestimated. We emphasize the critical importance of biopsy for the resolution of similar diagnostic dilemmas. Yet, obtaining consent for biopsy is not always a leading point in the communication with patients and their relatives. All efforts made for an accurate diagnosis are important, as properly chosen therapeutic options influence the prognosis.

Key words: 18F-FDG PET, Biopsy, Epilepsy, Glioblastoma, Multiple sclerosis,

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Please cite this article in PubMed Style or AMA (American Medical Association) Style:
Dimitrov IN, Kaprelyan AG, Georgiev R, Ivanov BD, Enchev Y, Avramov T, Grudkova MV, Deleva NS. Rare Clinical Case of Glioblastoma Multiforme, Multiple Sclerosis and Epilepsy: Clinical, MRI and 18F-FDG PET Study. J of IMAB. 2015 Oct-Dec;21(4):908-913.

Correspondence to: Ivan Dimitrov, MD, PhD; First Clinic of Neurology, Sveta Marina University Hospital; 1, Hristo Smirnenski str., 9010 Varna, Bulgaria; E-mail:

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Received: 01 September 2015
Published online: 13 November 2015

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