What are the common presenting symptoms of glioblastoma in adults aged 45–70?

Glioblastoma Presenting Symptoms in Adults

The most common presenting symptoms of glioblastoma in adults aged 45-70 are new-onset seizures and cognitive impairment, followed by focal neurological deficits (such as weakness or sensory disturbances) and symptoms of increased intracranial pressure. 1

Primary Symptom Categories

Seizures

• New-onset epilepsy is one of the two most frequent presenting symptoms in glioblastoma patients 1
• Seizures occur more commonly in younger patients within the 45-70 age range (closer to age 45) 2
• Seizures as a presenting symptom correlate negatively with patient age—older patients are less likely to present with seizures 2

Cognitive and Neurocognitive Impairment

• Cognitive disorders represent the other most common presenting symptom, particularly in older patients within the 45-70 range 1, 2
• Cognitive impairment correlates positively with both increasing age and higher tumor grade 2
• Patients presenting with cognitive disorders are typically older than those presenting with seizures 2
• Neurocognitive deficits may be subtle initially and require formal assessment beyond basic screening 1

Focal Neurological Deficits

• Motor deficits (pareses/weakness) and sensory disturbances are characteristic presenting features 1
• Hemiparesis is specifically mentioned as a common focal deficit 1
• Aphasia occurs when tumors affect language areas 1
• The specific deficit pattern depends on tumor location, though anatomical location does not significantly predict which symptoms will occur 2

Increased Intracranial Pressure Symptoms

• Symptoms and signs of elevated intracranial pressure occur as a presenting feature 1
• Contrary to common belief, headache is NOT a common presenting symptom in glioblastoma and rarely appears as a sole symptom 2
• When present, headache typically occurs with other neurological symptoms 2

Temporal Pattern of Symptom Evolution

Rapid Progression

• Glioblastoma typically causes symptoms only weeks before diagnosis, reflecting its fast-growing nature 1
• This rapid symptom evolution distinguishes glioblastoma from lower-grade gliomas that may cause symptoms for years 1

Non-Specific Prodrome

• In the year before diagnosis, most patients report non-specific symptoms such as fatigue or headache 1
• These vague symptoms often do not prompt immediate medical evaluation 1

Clinical Examination Findings

Neurological Assessment

• Physical examination focuses on detecting focal neurological deficits corresponding to tumor location 1
• The Neurological Assessment in Neuro-Oncology (NANO) scale can document examination findings 1
• Performance status assessment (Karnofsky Performance Score) is essential for treatment planning 1

Cognitive Screening

• Formal neurocognitive assessment beyond Mini Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA) is increasingly standard 1
• MMSE remains widely used as a screening instrument despite limitations 1

Critical Clinical Pitfalls

Headache Misconception

• Do not rely on headache as a primary diagnostic indicator—it is uncommon and does not appear as an isolated symptom in glioblastoma 2
• The classic teaching that brain tumors present with headache is not supported by modern evidence 2

Age-Related Symptom Patterns

• Expect cognitive symptoms more frequently in patients closer to age 70, while seizures are more common in patients closer to age 45 2
• Tumor grade significantly correlates with cognitive disorder presentation (higher grade = more cognitive symptoms) 2

Multifocal Disease

• Multifocal tumors occur in approximately 22% of glioblastoma cases and represent an independent negative prognostic factor 3
• Multifocal presentation does not significantly alter the symptom profile but affects prognosis 3

Incidental Findings

• Some glioblastomas are discovered incidentally on imaging performed for other reasons, though this is less common 3
• Even incidentally discovered tumors typically have subtle symptoms upon careful history-taking 1