Unexplained cerebral hemiatrophy in a case of astrocytoma, IDH-Mutant, WHO grade 3: a case report and literature review

Cerebral hemiatrophy is a known sequela of perinatal insults, autoimmune encephalitides, ischemic stroke, vascular abnormalities, infection, head trauma, and neoplasms. Documented cases of primary brain tumor-associated hemiatrophy have been described mostly in germinoma cases, with only four cases involving astrocytomas. We describe the clinical presentation, imaging, and course of a 30-year-old patient with a left frontal astrocytoma, isocitrate dehydrogenase (IDH) mutant, World Health Organization (WHO) grade 3; the patient initially presented with global aphasia out of proportion to the degree of language cortex involvement, and within two months after tumor resection, began to show imaging findings of cerebral hemiatrophy and crossed cerebellar diaschisis. We review existing cases of cerebral hemiatrophy within the literature and proposed mechanisms of pathology.