Clinical Reasoning: Worsening neurologic symptoms in a brain tumor patient.

SECTION 1 A 65-year-old woman diagnosed with a right parietal-occipital glioblastoma after presenting with hemianopia was treated with 2 surgical resections including carmustine wafer placement, radiotherapy with concurrent chemotherapy with temozolomide, and adjuvant chemotherapy with temozolomide and bevacizumab, an anti-angiogenic agent targeting vascular endothelial growth factor (VEGF). Seven months after the diagnosis, while receiving temozolomide and bevacizumab, the patient developed headaches, subtle gait ataxia, memory difficulties, lethargy, and back pain, progressive over 3 weeks. She eventually developed a generalized tonic-clonic seizure and was brought to an urgent care facility.