An unusual case of stroke in a young Indian male, presenting with recurring hemiparesis-diagnosis aided by the use of susceptibility weighted magnetic resonance imaging and computed tomography

Germinoma is the most common and least malignant intracranial germ cell tumour, usually found in the midline. Basal ganglia and thalamic germinoma, called ectopic germinoma, is a rare and well documented entity representing 5% to 10% of all intracranial germinomas and has been reported extensively in young Asian males. The association of cerebral and/or brain stem atrophy with basal ganglia- thalamic germinoma on computed tomography (CT) and magnetic resonance imaging (MRI) is found in 33% of the cases. Although early treatment with chemo radiotherapy can be curative and significantly improve the quality of life, medical attention is often delayed due to the unusual imaging morphology of these lesions. We describe a case of a young 19-year-old Indian male who presented initially with recurring monoparesis after an episode of trauma, which then progressed slowly to hemiparesis and unusual features over a period of 2 years. The initial and subsequent imaging findings are described in this article and the value of susceptibility weighted MRI and CT imaging in arriving at the diagnosis is highlighted. The diagnosis was proven by positron emission tomography/CT (PET-CT) and biopsy, following which the patient was started on chemo-radiotherapy and is under follow up.