Thrombosis of Internal Carotid Artery after Cisplatin-Based Chemotherapy

later, she found him lying by the bed unable to communicate and unable to move his right limbs. On admission 3 h later, he was somnolent, globally aphasic, and he had central paresis of the facial nerve and spastic hemiplegia with brisk reflexes and extensor plantar response on the right side. There were no clinical signs of deep venous thrombosis. A few months earlier, he had been diagnosed as having testicular seminoma. A day prior to the admission, he had finished the second cycle of chemotherapy – etoposide and bleo mycin regimen (bleomycin 15 mg/day con tinuous infusion over 3 days, etoposide 100 mg/m 2 / day over 5 days, cisplatin 20 mg/m 2 /day over 5 days), which he had received after orchiectomy on the right because of retroperitoneal metastases. He had no other diseases or risk factors for cerebrovascular diseases and was taking no other medications. He had not had any abdominal surgery for retroperitoneal metastases either. On admission he was hemodynamically stable with a blood pressure of 150/ 102 mm Hg, normal body temperature and laboratory results that showed signs of early inflammation [C-reactive protein (CRP) ! 5 mg/l, leukocytes 10.3 ! 10 9 /l, 90% segmented neutrophiles]. A day later, the body temperature increased (38.3 ° C), and the blood pressure dropped (104/77 mm Hg). We found no other clinical signs of infection. However, laboratory measures Dear Sir, The role of a malignant disease as a risk factor for cerebrovascular disorders is established and mechanisms are well determined [1] . Less commonly, the increased risk may also be due to vascular toxicity of chemotherapy [2] . The past sporadic case reports of acute cardiovascular events in young men receiving chemotherapy containing cisplatin for testicular cancer have raised concern that these events may be treatment-related complications and impugn the safety of such treatment [3–7] . Particular association was suggested between cisplatin-based chemotherapy and ischemic stroke [8–10] . Nevertheless, although such cases are rare, they may appear occasionally [7] . Today, about 80% of metastatic testicular cancer patients can be cured by 3–4 cycles of chemotherapy containing cisplatin, etoposide and bleomycin [11] . This treatment of testicular cancer is definitely effective, but occasional reports of complications speak in favor of the need of supporting the continued research of strategies to minimize toxicity in patients with favorable prognosis [12] .