Concurrent Wounded Glioma Syndrome and Distant Wounded Glioma Syndrome Following a Gross Total Resection of Glioblastoma: A Case Report

Surgery is the initial form of treatment for glioblastoma, and a maximum resection without impairing neurological function improves survival. Wounded glioma syndrome (WGS) is a clinical picture observed after the resection of high-grade tumors. This syndrome, developing within hours to a few days after glioma surgery, is characterized by hemorrhage into the postoperative cavity and cerebral edema and at times occurs in areas distant from the site of the resection, i.e., distant wounded glioma syndrome (DWGS). We report a case of a 70-year-old male presenting with acute-onset left leg weakness, with a large peripherally enhancing mass with central non-enhancement suggestive of necrosis in the right frontal lobe. A gross total resection of the tumor was done, and the histopathologic evaluation verified the diagnosis of glioblastoma World Health Organization (WHO) grade IV. During the postoperative period, he was drowsy and was able to move his right extremities. He had a series of generalized tonic-clonic seizures three hours after the operation. After eight hours, the patient became comatose with signs of increasing intracranial pressure. A cranial computed tomography (CT) scan revealed diffuse cerebral edema and hemorrhage into the operative site in the right frontal lobe, as well as subarachnoid hemorrhages in the bilateral frontoparietal sulci. There were also small hemorrhages seen in the left caudate head, midbrain, and left hemipons. Death occurred the following day. This case report demonstrates an unusual case of a WGS with a concurrent DWGS in the brainstem after a gross total resection of a frontal lobe glioma. This case shows a significantly uncommon sequela that a patient undergoing glioma surgery can present, leading to rapid deterioration and death. Resection of a glioma carries a significant risk, and its impact in the immediate postoperative period merits evaluation when planning perioperative management, taking prompt action if these syndromes occur.