精巣腫瘍に対しcisplatin-based chemotherapyを施行し，脳静脈洞血栓症の併発を認めた1例

Cerebral Venous Sinus Thrombosis Following Cisplatin-Based Chemotherapy for Testicular Tumor

Ⅰ．はじめに

　Cisplatinは多くの固形癌に使用される白金製剤であり，その副作用には腎毒性や催吐作用などのほかに静脈血栓塞栓症（venous thromboembolisms：VTEs）があるが，脳静脈洞血栓症の発症は比較的稀である．

　今回われわれは，精巣腫瘍の後療法としてのcisplatin-based chemotherapy中に，脳静脈洞血栓症を発症した症例を経験したので，若干の文献的考察を加えて報告する．

　A man in his 30s who presented with an enlarged right testicle was diagnosed with a germ cell tumor via orchiectomy. Adjuvant chemotherapy with cisplatin, etoposide and bleomycin（BEP）was initiated. He developed a headache 8 days later, followed by neurological deficits 10 days later. Magnetic resonance imaging（MRI）and magnetic resonance venography（MRV）showed thrombotic occlusion at the superior sagittal sinus. Anticoagulant therapy with heparin was initiated. However, a generalized epileptic seizure occurred 11 days later, and an antiepileptic drug therapy was initiated. The headache and neurological deficits gradually improved, and MRI findings showed that the superior sagittal sinus had re-canalized.

　The main cause of the sinus thrombosis in this patient was considered dehydration and cisplatin-induced hypercoagulability. Five courses of BEP therapy were carried out with care to avoid dehydration. The patient has remained free of testicular tumor recurrence, metastasis, and cerebral sinus thrombosis for 2 years.

　Cisplatin-based chemotherapy is an established risk factor for venous thromboembolism（VTE), and cerebral sinus thrombosis is a rare but dangerous complication. Therefore, cerebral sinus thrombosis should be considered when patients with testicular cancer who undergo cisplatin-based chemotherapy start to develop neurological symptoms. Clinicians should be aware of this treatable complication.