Glioblastoma Presenting Only as Cortical "Ribbon Sign" in the Early Stage: A Case Report and Literature Review

Background: Glioblastoma (GB) is the most common primary malignant brain tumor and occurs predominantly in the white matter of the brain. MRI often shows an irregular mass with uneven internal signals, necrosis, surrounding edema and a space-occupying effect. The malignant degree of GB is high, and it often relapses after surgery. Case presentation: A 66-year-old male patient was admitted to our hospital due to sudden left superior strabismus and convulsions . During the patient’s first hospitalization, MRI showed only an abnormal cortical signal, and the diagnosis was viral encephalitis.After the treatment of antiepileptic, antiviral and relieving brain edema, the patient was discharged. Seven months later, he was admitted to the hospital again because of memory impairment and slow reaction speed. MRI showed that there was an obvious mass in the original lesion area, and this was diagnosed as glioblastoma. Postoperative pathology confirmed glioblastoma (WHO) grade IV. Conclusions: : The clinical diagnosis, treatment and imaging manifestations of this case of GB are reported as follows to improve understanding of this type of GB, which only has cortical abnormal signals in the early stage, to reduce misdiagnosis.