Cisplatin-based chemotherapy is a possible risk factor for cerebral stroke in patients with testicular germ cell tumour - a case report and review of the literature.

Abstract

Cerebral stroke secondary to cisplatin-based chemotherapy in young patients undergoing chemotherapy for testicular germ cell tumour (GCT) has been reported only sporadically. Here, we report a 49-year-old man undergoing adjuvant chemotherapy with one cycle of bleomycin, etoposide, and cisplatin for nonseminomatous testicular GCT clinical stage 1b. On the sixth day of treatment, a sudden onset of right-sided hemiparesis and aphasia prompted computed tomography and angiography. An occlusion of the left middle cerebral artery was detected. The patient recovered after immediate thrombolytic therapy, but minor neurological deficits were present 9 months after the event. Among 221 GCT patients undergoing cisplatin-based chemotherapy during 2017-2025, one stroke occurred, revealing a relative incidence of 0.45% in this cohort. A literature survey yielded 31 previous GCT cases with a median age of 35 years, most of them were caused by occlusion of brain supplying arteries. Thrombotic occlusions of brain-supplying arteries secondary to cisplatin-based chemotherapy can arise in otherwise healthy young men with no risk factors for vascular disease. Care givers of GCT patients must be cognizant of such events upon counselling patients before chemotherapy, because this complication of treatment may foil the attempts of restoring health in a basically well curable disease.