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Salah Almubarak, MD; Yee-Chiung Gan, FRCS; Paul Steinbok, MBBS, FRCSC; Glenda Hendson, MBBCh, FRCPC; Ken Poskitt, MDCM, FRCPC; Helen Nadel, MD, FRCPC; Karen Goddard, FRCPC, FRCP(UK); Juliette Hukin, MBBS, FRCPC

Arch Neurol. 2009;66(6):789-792.

Objective  To report a case series in which basal ganglia calcifications without mass effect proved to be germ cell tumors.

Design  Case series.

Setting  Tertiary care hospital.

Patients  Four patients.

Interventions  Computed tomography, magnetic resonance imaging, positron emission tomography, biopsy, chemotherapy, and radiation therapy.

Main Outcome Measures  Recognition of clinical syndrome and radiological features.

Results  All patients had progressive hemiparesis, and 1 patient also had frontal lobe dementia. Imaging demonstrated progressive asymmetric signal abnormality with basal ganglia calcification and associated brainstem atrophy. Fludeoxyglucose F 18–positron emission tomography showed hypometabolism in contrast to malignant glioma.

Conclusion  Germ cell tumor should be considered in patients with an indolently progressive neurological course, particularly if basal ganglia calcification is present with or without enhancement, asymmetric brain atrophy, or a mass.

Author Affiliations: Divisions of Neurology (Drs Almubarak and Hukin), Neurosurgery (Drs Gan and Steinbok), Neuropathology (Dr Hendson), Neuroradiology (Dr Poskitt), Nuclear Medicine (Dr Nadel), and Oncology (Drs Goddard and Hukin), BC Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.

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