• Ryosuke Matsuda, Mitsutoshi Nakamura, Yoshitaka Tanaka, Yoshiaki Takamura, Ichiro Nakagawa, and Yasushi Motoyama.
• Department of Neurosurgery, Nara Medical University, Kashihara, Japan. Electronic address: cak93500@pop02.odn.ne.jp.
• World Neurosurg. 2018 Dec 1; 120: 54-58.

BackgroundGlioblastoma is the most common primary malignant tumor of the brain. Common radiologic findings using initial computed tomography (CT) reveal an intra-axial lesion with perifocal edema. Here, we present a rare case of diffuse subarachnoid hemorrhage (SAH) detected on an initial CT image in a patient without intracranial aneurysm in whom the final diagnosis was glioblastoma.Case DescriptionWe report the rare case of a 57-year-old man with glioblastoma in the right temporal lobe who presented with a sudden onset of disturbance of consciousness as an initial manifestation. Initial CT of the head revealed a diffuse SAH. Digital subtraction angiography revealed no cerebral aneurysm or dissection of intracranial arteries. The patient was treated for SAH of unknown etiology with conservative therapy, and a repeat digital subtraction angiography demonstrated no vascular disease. Eventually, he was discharged without any neurologic deficit. A follow-up CT of the brain revealed an intracerebral hemorrhage in the right temporal lobe, and magnetic resonance imaging revealed a ring enhancing lesion in the anterior section of right temporal lobe. The patient was transferred to our department, where he underwent surgical resection, and a pathologic diagnosis of glioblastoma was made.ConclusionsWe present a rare case of glioblastoma mimicking SAH of unknown etiology and recommend including glioblastoma in the differential diagnosis of SAH of unknown etiology.Copyright © 2018 Elsevier Inc. All rights reserved.

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