Abstract
Germ cell tumors are rare tumors and may pose a diagnostic dilemma. We present a 15-year-old
boy with insidious onset right hemiparesis followed by polyuria and polydipsia. Later,
he also developed cognitive decline and speech disturbances. Serial magnetic resonance
images (MRIs) over a 2-year period showed progressive atrophy of the left caudate
nucleus, along with Wallerian degeneration of the left internal capsule and crus of
midbrain. Further in the course, imaging revealed an ill-defined signal intensity
involving left ganglio-capsulo-thalamic region with increased perfusion which was
suggestive of basal ganglia germinoma. Beta human chorionic gonadotropin levels were
mildly elevated. This case illustrates an uncommon presentation of a central nervous
system germinoma which is often misdiagnosed in the early stages because of its atypical
symptomatology and MRI findings.
Keywords
basal ganglia germinoma - adolescent - progressive hemiparesis - ganglio-capsulo-thalamic
signal on MRI - mildly elevated β-HCG
