N16) Headache and new-onset seizures

Review the Learning Outcomes, Hx, PE and Labs, and begin the module with your Provisional Diagnosis. Keep hitting "Next" to move through the module.

Learning Outcomes

  1. Articulate your relationship with the consulting diagnostic radiologists in the evaluation of a patient with a headache.
  2. Review the DDx considerations in a patient with a headache.
  3. Identify the spectrum of imaging findings in appropriate modalities for evaluating patients with a headache.


Physical Exam


Provisional Diagnosis

Select the Dx you believe is most appropriate
This patient’s new onset seizure occurring after a worsening headache with nausea and dysarthria are concerning for an intracranial mass lesion. A toxic ingestion is unlikely given the chronicity of symptoms and negative labs. Multiple sclerosis and ischemic strokes are unlikely to cause a seizure.
Well done. You were correct

Potential Acuity

What is your assessment of the likely acuity for this patient?

Well done. You were correct
The patient requires urgent workup and management.

First Imaging Study

What is the first imaging study you will order?

A brain CT with and without contrast is a good initial, quickly obtainable, imaging modality to evaluate for a brain tumor. This patient did not initially undergo a CT, so we review the MRI.
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Pertinent Imaging Observations

Click on the links below to view images from the study, and assess these key findings as best you can.

Watch our video

View the full study if you'd like to take a look yourself.

Second Imaging Study

What is the next imaging study you will order?

No further imaging is required as the diagnosis is strongly suggested with the brain MRI.
Well done. You were correct

What is your Diagnosis now that you have seen the imaging results?

The imaging findings are highly consistent with a glioblastoma.

Current Acuity

Initially, you selected and we suggested acuity.

Has your concern for this patient changed?

The patient requires urgent workup and management.

Assessment and Plan

Please provide your assessment and plan for this patient

A 65-year-old male is presenting with a newly diagnosed glioblastoma after new onset of seizures in the setting of progressively worsening headaches and dysarthria. Neurosurgery and neuro-oncology should be urgently consulted for evaluation. In the interim, the patient should be made NPO and started on IV fluids should he require surgery.

Lessons Learned:
- Glioblastomas, which are high-grade gliomas, are the most common primary brain tumors in adults, with a median age of onset of approximately 55 to 60.
- Glioblastomas are highly malignant, rapidly progressive brain tumors. The patient’s presentation will depend on the location of the tumor.  
- Imaging classically shows a heterogeneous lesion with central necrosis and irregular peripheral enhancement that leads to vasogenic edema. Sometimes, there is a “butterfly configuration” as it crosses the midline through the corpus callosum.

Socioeconomic Factors: Higher SES is strongly associated with increased risk of glioblastoma.

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