Cisplatin-associated occlusion of the internal carotid artery.

BACKGROUND

Cisplatin is a highly effective antineoplastic agent used also in germ cell cancer. Thromboembolic complications like pulmonary embolism, myocardial infarction and stroke have occasionally been reported.

CASE REPORT: A 46-year-old man with seminoma and without any cerebrovascular risk factors developed an acute stroke with complete right-sided hemiparesis and global aphasia, during the second cycle of cisplatin-based chemotherapy. After exclusion of an intracerebral bleeding, a systemic thrombolysis was performed. Further diagnostics revealed an acute occlusion of the left carotid internal artery with infarction in the territory of the middle cerebral artery. The patient slowly recovered; however, a moderate aphasia and partial hemiparesis persisted whereas the tumor was in complete remission. Months later, the patient developed symptomatic epilepsy.

CONCLUSIONS

Ischemic stroke associated with cisplatin-based chemotherapy is rare, but may be disabling or even fatal. With regard to the literature, several precautions are discussed to minimize the risk of these major side effects.