Introduction:

High-grade gliomas are the most common and most lethal primary cancers of the central nervous system. Glioma patients with initial symptoms of cerebral hemorrhage are prone to clinical misdiagnosis and delayed diagnosis.

Case summary:

This paper reports the clinical data of a 40-year-old man with glioma who initially presented with cerebral hemorrhage. Cerebral computed tomography (CT) revealed left parietal cerebral hemorrhage, while contrast-enhanced magnetic resonance imaging (MRI) revealed abnormal enhancement of the left frontoparietal junction, indicating internal bleeding of metastatic tumor. Pathological examination confirmed a high-grade glioma, with immunohistochemistry indicating positive glial fibrillary acidic protein (GFAP) and 40% Ki-67 positive labeling. Consequently, the patient received a final diagnosis of glioma (WHO grade IV).

Conclusions:

We report an interesting case in which glioma initially presented with cerebral hemorrhage. Therefore, gliomas should be considered as a possible cause of cerebral hemorrhage in patients without risk factors for hemorrhage.