Acute Stroke Secondary to Carotid Artery Dissection in a Patient with Germ Cell Tumour: Did Cisplatin Play a Role?

Abstract

Background: Cisplatin-based chemotherapy – mainly the bleomycin, etoposide and cisplatin (BEP) regimen – has significantly improved the prognosis of testicular germ cell tumours (GCT). However, it has serious vascular side effects, including acute ischemic stroke. Case Report: A 37-year-old man with no conventional cerebrovascular risk factors presented with right arm clumsiness followed by a transient episode of expressive dysphasia 3 h later. He was receiving the third cycle of BEP for metastatic retroperitoneal GCT. Brain computed tomography (CT) and diffusion-weighted magnetic resonance imaging (MRI) confirmed multiple acute infarctions in the left middle cerebral artery territory. MR angiography and CT angiography showed a dissection with flaps extending into the left internal and external carotid arteries. The patient was anticoagulated and made an almost complete recovery. Conclusion: Carotid artery dissection has not been reported as the cause of cisplatin-associated stroke in patients with GCT. This case demonstrates the potential for cisplatin-induced mechanisms causing carotid dissection, particularly considering the close temporal association of BEP and the event in our patient. In young patients with excellent curative potential from GCT, every effort should be made to minimise the risk of disabling side effects of BEP. After a stroke, imaging of intracranial and extracranial arteries, monitoring and correction of serum magnesium is recommended. The decision to continue or discontinue cisplatin-based chemotherapy should be individualised.

Peripheral Blood Gene Expression Profiling Reveals Molecular Pathways Associated with Cervical Artery Dissection

“…The connection between ribosome biogenesis and tumor transformation was supported by accelerated ribosome biogenesis in actively dividing tumor cells [46]. Spontaneous dissection of the coronary [47][48][49][50] and cervical arteries [51][52][53] has been described as a side effect of chemotherapy, which inhibits rRNA transcription (dactinomycin, doxorubicin, oxaliplatin, etc.) or VEGF signaling (bevacizumab, ranibizumab, sorafenib, etc.)…”