• Madhivanan Karthigeyan, Chirag Kamal Ahuja, Debjyoti Chatterjee, and Pravin Salunke.
• Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Electronic address: karthigeyanm82@gmail.com.
• World Neurosurg. 2017 Apr 1; 100: 713.e1-713.e3.

BackgroundRadiologic differentiation between a low-grade and high-grade lesion is crucial when deciding extent of resection and prognostication. Occasionally, imaging features can be confusing between the 2 lesions. We report a case that presented such a radiologic dilemma. The lesion appeared benign and extra-axial on routine magnetic resonance imaging sequences. However, subtle clinical and imaging clues pointed to a high-grade lesion.Case DescriptionA 27-year-old woman presented with multiple cranial nerve palsies, gait ataxia, and features of increased intracranial pressure. Computed tomography and magnetic resonance imaging showed a petroclival extra-axial contrast-enhancing lesion with areas of chunky calcification. Although choline peak on spectroscopy raised suspicion of a high-grade lesion, the primary differential diagnosis included meningioma and schwannoma considering its characteristic imaging appearance. Postoperative histopathology showed the lesion to be giant cell glioblastoma.ConclusionsApart from reporting a rare variant of glioblastoma in an unusual location, this case highlights atypical imaging in a glioblastoma. Brainstem edema may be a subtle indicator of the infiltrative nature of a tumor. Magnetic resonance spectroscopy may be a useful adjunct in such circumstances.Copyright © 2017 Elsevier Inc. All rights reserved.

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