841 - An Unusual Case of Glioblastoma In A Patient With Deep Brain Stimulator For Trigeminal Neuralgia: A Case Report

Case Diagnosis: Glioblastoma

Case Description: A 55-year-old female patient with history of trigeminal neuralgia, deep brain stimulator (DBS) for pain modulation and chronic, non-intractable epilepsy was admitted to inpatient rehabilitation (IPR) after being evaluated for acute onset left-sided weakness. MRI was deferred due to lack of significant CT findings, and investigational use of her DBS was determined as a high risk for complication.

Initial exam revealed mild left hemiplegia, left hyperreflexia, and decreased right facial sensation.


Patient began developing worsening left hemiparesis and acute spasticity. Risk analysis for MRI was conducted. The potential risk of field current induction was found to be high while the static magnetic field interaction was determined to be low. MRI demonstrated several right brain lesions. Biopsy revealed glioblastoma. Patient was treated and ultimately discharged home on hospice.

Discussions: Electromodulation for somatosensory pain has been in practice since the 1950s and is largely off-label. Trigeminal neuralgia is a disorder that causes facial pain and headaches. Typical treatments include medical and surgical management. DBS has been used as a treatment option in patients that have failed management. Glioblastoma is also known to cause symptoms similar to trigeminal neuralgia.

Patient experienced months of intermittent dysarthria, dizziness, and nausea. Patient also reported weakness after DBS battery replacement one month prior to hospitalization. In addition to using DBS for pain, the patient was using intranasal ketamine and lorazepam chronically for headache management. Her most recent MRI two years prior to this hospitalization did not show evidence of brain lesions.


Conclusions: This case demonstrates the significant overlap between glioblastoma and trigeminal neuralgia. The patient was using DBS alongside anti-epileptics, anti-nausea, and ketamine therapy for years. These treatments made identifying glioblastoma challenging. This case further highlights the importance of recognizing acute neurological changes, obtaining advanced imaging, and performing risk analysis to scan patients using devices for off-label indications.