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49-year-old woman presented with headache and episodes of mild disorientation over last 4 days, was found on the floor last night with R hemiparesis and severe confusion.
Brain MRI: There is a 5 x 4 x 3.2 cm irregularly enhancing mass in the L occipito-parietal region with extensive vasogenic edema and marked mass effect on adjacent brain.
Grayish mass extends to the cortical surface and almost to the dura. Gross total resection of the tumor was performed, identifying a clear margin superiorly, laterally, inferiorly down to the tentorium and medially to the falx. Six BCNU wafers were placed against the edematous white matter.
Brain, L occipital region biopsy: glioblastoma.
L occipital/parietal brain mass resection: glioblastoma multiforme (WHO grade IV).
Surgery and Chemotherapy: L craniotomy with gross total resection of tumor and placement of BCNU chemotherapy wafers.
Radiation: Started beam radiation to brain: 4500 cGy 6MV with boost 1620 cGy 6MV total dose 6120 cGy