Glioblastoma, IDH-Wildtype, Developing in the Territory of a Prior Hemorrhagic Stroke: A Case Report

Abstract Glioblastoma (GBM) is a highly aggressive brain tumor with poor prognosis, marked by vascular endothelial growth factor -driven angiogenesis. Hemorrhagic stroke causes cerebral vessel rupture, hypoxia, and neuronal injury, and may trigger reactive gliosis—a process implicated in malignant transformation. We report a 54-year-old man who developed GBM in the same region previously affected by a venous hemorrhagic stroke, suggesting a potential link between cerebrovascular injury and GBM pathogenesis. A 54-year-old man with no oncogenic risk factors developed GBM in the right temporoparietal region previously affected by a spontaneous venous hemorrhagic stroke in May 2025. Initial conservative management was followed by MRI findings of a chronic post-hemorrhagic lesion; subsequent MR spectroscopy in September 2025 revealed metabolic changes suggestive of malignancy (↑choline, ↑lactate, ↓ N-acetyl aspartate). Craniotomy and histopathology confirmed GBM, showing classic features including palisading necrosis, microvascular proliferation, and hemosiderin-laden macrophages. This case underscores the diagnostic difficulty in distinguishing post-stroke changes from tumor recurrence and suggests a possible association between cerebrovascular injury and GBM pathogenesis. While rare, GBM should be considered in patients with new neurological decline at a prior hemorrhagic stroke site, particularly when imaging reveals a progressive mass. This case highlights a potential association between cerebrovascular injury and gliomagenesis, though causality remains unproven. Early histopathological confirmation is essential to distinguish neoplastic processes from post-stroke sequelae.