Brain infarction as the initial presentation of primary posterior mediastinal seminoma

A 40-year-old man was admitted with acute onset of slurred speech and right hemiparesis. Cerebral infarction was diagnosed from magnetic resonance (MR) images. Chest X-ray incidentally revealed a posterior mediastinal tumour, which proved to be seminoma on CT-guided biopsy. The patient then received chemotherapy. Five months later, right upper limb weakness and slurred speech occurred again. Brain MR images revealed two metastatic lesions in the prior infarct areas, which on histology proved to be metastatic seminoma.