Abstract Details

Title Glioblastoma and Disseminated Intravascular Coagulation: Literature Review and Illustrative Case

Topic Neuro-oncology

Presentation(s) P2 - Poster Session 2 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-017

Objective To investigate the co-occurrence of central nervous system malignancies and disseminated intravascular coagulation (DIC).

Background Solid organ malignancies and lymphoma are well known to trigger DIC. Glioblastoma is a malignant primary brain tumor, which has a rare association with DIC.

Design/Methods We performed a National Library of Medicine search using the terms glioblastoma multiforme and disseminated intravascular coagulation. Nine publications were found, only 4 were relevant.

Results A 59-year-old man with history of panhypopituitarism after resection of a sellar meningioma. He presented to clinic with 3 weeks of left hemibody numbness and right eye vision loss. Imaging demonstrated multi-centric ring-enhancing right thalamic and brainstem lesions. Two days later, he presented to our emergency department with worsened vision loss, and left hemiplegia, imaging showed an acute intracerebral hemorrhage (ICH) into the prior area of potential tumor. He was stabilized overnight and had evacuation of the hematoma as well as biopsy of the lesion the following day. The patient entered DIC within a few days of surgery and developed acute kidney and multiorgan failure, in addition to bilateral femoral deep vein thrombosis. An intravascular filter was placed but despite this and low dose subcutaneous heparin he had pulseless electrical activity cardiac arrest and died. Postmortem brain examination confirmed an aggressive glioblastoma with microscopic vascular proliferation and necrosis.

Conclusions

The co-occurrence of glioblastoma and DIC is rare with five cases reported. Some occurred with spontaneous intracranial hemorrhage (ICH) within the tumor and others resulted after intracranial surgery as in this case. The spontaneous ICH cases were discovered to possess endogenous tissue plasminogen activator (TPA) like substances secreted from jugular vein sampling. Future studies should identify patients with thromboelastography at highest risk for TPA and employ antifibrilinolytics to halt the hemorrhage. These patients may be hypercoagulable as well thus posing major management dilemma.

Authors/Disclosures
PRESENTER	No disclosure on file
Rana Hanna AL-Shaikh, MD (Mayo Clinic Florida)	Dr. Hanna AL-Shaikh has nothing to disclose.
Tasneem F. Hasan, MD (Tasneem F Hasan MD PC)	Dr. Hasan has nothing to disclose.
	No disclosure on file
Alfredo Quinones-Hinojosa	Alfredo Quinones-Hinojosa has nothing to disclose.
	No disclosure on file
Julie E. Hammack, MD, FAAN (Mayo Clinic Jacksonville)	Dr. Hammack has nothing to disclose.
	No disclosure on file
	No disclosure on file
Zbigniew K. Wszolek, MD, FAAN (Mayo Clinic- Jacksonville)	Dr. Wszolek has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Polish Neurological Society/Via Medica. Dr. Wszolek has received intellectual property interests from a discovery or technology relating to health care.
William D. Freeman, MD, FAAN (Mayo Clinic)	Dr. Freeman has nothing to disclose.

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