title: Germinoma in the bilateral basal ganglia presented with cognitive deterioration.
abstract: OBJECTIVE
  Here, we report a case of pediatric germinoma located in the bilateral basal ganglia, which presented with severe cognitive deteriorations.
  
  
  METHODS
  A 15-year-old boy presented with decreased school performance and mild cognitive disturbances. Magnetic resonance images (MRI) of the brain revealed T2 hyperintensity in the bilateral basal ganglia. The patient was initially observed by a local hospital and had screening for metabolic diseases or inflammatory diseases. Lesions with similar characteristics were also found in the pituitary stalk and infundibulum, and these lesions were enhanced with gadolinium (Gad). MR spectroscopy suggested that these should be neoplastic lesions other than metabolic or inflammatory diseases. Biopsy was performed with ventriculoscope, which proved all lesions of infundibulum, pineal, and basal ganglia were pathologically germinoma. The lesions responded well to the chemotherapy and radiation, and his cognitive function improved significantly.
  
  
  CONCLUSIONS
  A case of germinoma in the bilateral basal ganglia which significantly affect cognitive functions is reported. Differential diagnoses of cognitive symptoms are various, but germinoma could be considered as a possible pathology for it. Early MRI and tumor marker exams are recommended, unless organic brain diseases are completely denied. MR spectroscopy and biopsy with ventriculoscope are useful for diagnosis.
authors.affiliation: Department of Neurosurgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 420-8660, Japan, watayatakafumi@yahoo.co.jp.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Wataya
authors.forename: Ryuji
authors.initials: R
authors.lastname: Ishizaki
authors.forename: Masashi
authors.initials: M
authors.lastname: Kitagawa
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Tashiro
mesh_terms: D000293:Adolescent; D001224:Aspartic Acid / Q000031:analogs & derivatives / Q000378:metabolism; D001479:Basal Ganglia / Q000473:pathology* / Q000601:surgery; D001932:Brain Neoplasms / Q000150:complications* / Q000473:pathology* / Q000628:therapy; D003072:Cognition Disorders / Q000209:etiology*; D003401:Creatine / Q000378:metabolism; D018237:Germinoma / Q000150:complications* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D009682:Magnetic Resonance Spectroscopy; D008297:Male; D014057:Tomography, X-Ray Computed
chemical_list: D001224:Aspartic Acid; C000179:N-acetylaspartate; D003401:Creatine