# Behavioral Changes and Refractory Hypertension as the First Manifestations of Anaplastic Astrocytoma: A Case Report

## TL;DR

A 66-year-old woman's first signs of a brain tumor were personality changes and severe, treatment-resistant hypertension, highlighting the importance of early investigation for brain tumors in older adults.

## Contribution

This case report highlights behavioral changes and refractory hypertension as rare initial signs of anaplastic astrocytoma.

## Key findings

- Personality changes and treatment-resistant hypertension were the first signs of anaplastic astrocytoma in an elderly patient.
- Neuroimaging revealed a large tumor in the right temporal lobe, confirmed as WHO grade III anaplastic astrocytoma.
- The patient's condition worsened rapidly despite radiotherapy, leading to death within two months of diagnosis.

## Abstract

High-grade brain tumors are uncommon malignancies with poor survival prospects. Their early manifestations can be vague, often resulting in diagnostic delays. Here, we report a case of a 66-year-old woman who exhibited only subtle personality changes and an episode of severe, treatment-resistant hypertension as initial signs of a malignant neoplasm in the brain. These findings prompted neuroimaging, which revealed a large tumor in the right temporal lobe. A biopsy confirmed an anaplastic astrocytoma (WHO grade III). Because of its deep location, surgical removal was not feasible, and radiotherapy was initiated. However, the patient’s condition rapidly worsened due to severe infection, and she died two months after diagnosis. This case underscores the need for vigilance in primary care: even mild behavioral changes or atypical symptoms such as unexplained hypertension in older adults should prompt early investigation for possible brain tumors.