Trombosis venosa cerebral

Case Rep Oncol 2011;4:555–559 DOI: 10.1159/000334850

Published online: © 2011 S. Karger AG, Basel November 29, 2011 ISSN 1662–6575
www.karger.com/cro

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This is an Open Access article licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0 License (www.karger.com/OA-license), applicable to the online version of the article only. Distribution fornon-commercial purposes only.

Two Cases of Cerebral Sinus Venous Thrombosis Following Chemotherapy for Non-Seminomatous Germ Cell Tumor
C. Papeta
a

A. Gutzeitb

M. Plessa

Medical Oncology and bDepartment of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland

Key Words Germ cell tumor · Cisplatin · Cerebral sinus venous thrombosis Abstract We report on two patients withcerebral sinus venous thrombosis following chemotherapy with cisplatin, bleomycin and etoposide for non-seminomatous germ cell tumor. Headache and neurological deficits were the leading symptoms. Cancer and cisplatin chemotherapy are well-known risk factors for thromboembolic events. The therapeutic strategy is an anticoagulant therapy. Symptoms are usually reversible within weeks under this therapy.Therefore, in patients with testicular cancer and chemotherapy who present with neurological symptoms, cerebral sinus venous thrombosis should be considered in the differential diagnosis.

Case Report
Case 1 A 47-year-old man presented with a two-day history of weakness in the left limb, prickling in the left part of the body and headache. Two months before, a high-risk non-seminomatous germ celltumor with embryonal carcinoma stage I according to the UICC/AJCC classification was diagnosed, with presence of lymphatic invasion. Adjuvant chemotherapy with two cycles of cisplatin, etoposide and bleomycin (BEP) was started four weeks after radical orchiectomy. At the time of his admittance he had received two full doses of cisplatin and etoposide and four full doses of bleomycin. Duringchemotherapy he suffered from asthenia, nausea, loss of appetite and dehydration requiring intravenous rehydration. The patient stopped smoking one year ago with a total of three pack years and drank up to two glasses of wine or beer daily until the start of the chemotherapy. Otherwise his medical history was unremarkable.

Miklos Pless

Medical Oncology, Cantonal Hospital Winterthur Brauerstrasse15 CH–8401 Winterthur (Switzerland) Tel. +41 52 266 2555, E-Mail miklos.pless @ksw.ch

Case Rep Oncol 2011;4:555–559 DOI: 10.1159/000334850

Published online: © 2011 S. Karger AG, Basel November 29, 2011 ISSN 1662–6575
www.karger.com/cro

556

Subsequent magnetic resonance imaging (MRI) scan showed a cerebral sinus venous thrombosis in the superior sagittal sinus (fig. 1), as well as inthe right sigmoid and both transverse sinuses with bilateral venous congestion associated with cytotoxic edema within the precentral gyri (fig. 2). Routine blood tests were normal. The patient was placed on anticoagulant therapy and a neurorehabilitation was started. Symptoms resolved completely within a month. The remaining chemotherapy with one administration of bleomycin was given. After threemonths, the MRI scan showed a residual thrombus in the right transverse sinus, the right sigmoid sinus and the superior sagittal sinus, respectively. The left transverse sinus was normal. The anticoagulant treatment was continued for a total treatment time of six months. So far, there has been no sign of a relapse of the testicular cancer. Case 2 A high-risk non-seminomatous germ cell tumor withembryonal carcinoma stage I, according to the UICC/AJCC classification, with presence of lymphatic invasion was found in a 29-year-old man. After three months of active surveillance, retroperitoneal lymphadenopathy was diagnosed and chemotherapy with three cycles of BEP was initiated. On day 10 of the second cycle the patient was admitted with a headache which had persisted for two days. On the...