(Kiosk 3) Incidental Finding of Diffuse Astrocytoma: A Case Report

Case Diagnosis: Twenty-eight year old, left-hand dominant male, with no significant past medical history or prior symptoms, presenting following a dirt bike accident, with incidental finding of diffuse astrocytoma, IDH-mutant, WHO grade 3.

Case Description or Program Description: Patient presented two days following a dirt bike accident; for which he was traveling approximately 40 mph at time of crash, wearing helmet. The patient reported a brief loss of consciousness, after which, he transported himself to a local hospital in Northern Arizona. He presented with neck pain, chest wall pain worsened with inspiration, mid-thoracic pain, and left-hand weakness. He denied symptoms prior to the accident, or other past medical history. Imaging revealed cervical and thoracic fractures, as well as a diffuse frontoparietal mass, read as an expansive, non-enhancing right frontoparietal mass, with suspicion for glial neoplasm. He was subsequently transferred to Barrow Neurological Institute for further management. The patient subsequently underwent right craniotomy with tumor resection and motor mapping. He was transferred to the Acute Rehabilitation Unit following medical stabilization.

Setting: Barrow Neurological Institute.

Assessment/Results: The patient was admitted to the Acute Rehabilitation Unit following the resection. Though initially agitated, requiring PRN Seroquel, the patient's level of cognitive functioning quickly improved. He was now with flaccid left hemiplegia. He tolerated and progressed through therapies well, regaining left wrist and hand control first. Upon discharge, the patient was still limited with his use of the left lower extremity, however, he had gained some tone which he used for stand-by-assist slide board and pivot transfers. The discharge plan included starting six weeks of chemoradiation upon discharge, with continuation of therapies outpatient.

Discussion (relevance): With the extent of this patient’s tumor burden, it is surprising that he did not appreciate deficits prior to his dirt bike accident. It is possible that he was experiencing subtle deficits which contributed to his loss of control, leading to his crash, however, this is unclear from the history obtained. The diffuse mass in this case was essentially an incidental finding.

Conclusions: Advanced brain masses may present with limited to no symptomatology, depending on tumor location and prior level of functioning.