Cardiac Myxoma Embolization Causing Ischemic Stroke and Multiple Partially Thrombosed Cerebral Aneurysms

Kesav, Praveen; John, Seby; Joshi, Priti; Gaba, Waqar Haider; Hussain, Syed

doi:10.1161/strokeaha.120.031679

Cited by 20 publications

(21 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The clinical manifestations and symptoms of cardiac myxomas vary and are not specific and can be divided into the following three groups: first, obstructive manifestations occur most frequently in approximately 50% of patients with atrial myxoma, including dizziness and dyspnea; second, embolization symptoms of myxoma, which affect more than one-third of patients with cardiac myxoma, and the presentations depend on the location of cardiac myxoma, such as pulmonary hypertension, chest pain, and severe headache; third, systemic symptoms, such as palpitation, fatigue, and fever, occur in approximately 58% of patients with cardiac myxoma (12,13). However, patients with cardiac myxoma can also be asymptomatic (14).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Biatrial Myxoma With Pulmonary Embolism and Cerebral Embolism: Clinical Experience and Literature Review

Ran

Chen

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

Cardiac myxoma is a common benign primary intracardiac tumor in the general population, and it is generally characterized as a benign tumor, and the morbidity of biatrial myxoma is low. Cases of biatrial myxoma in young patients are extremely rare. Furthermore, severe complications of cardiac myxoma, such as cerebral embolism, can have fatal consequences. Imaging can effectively assist in making a correct diagnosis and a safe and efficient surgical treatment plan. In this case report, we describe a unique case of a young woman who presented with biatrial myxoma accompanied by pulmonary embolism and cerebral embolism. Computed tomography pulmonary angiography (CTPA) detected multiple filling defects in the bilateral cardiac and bilateral inferior pulmonary artery basal branches. Transthoracic echocardiography (TTE) revealed irregular isoechoic masses in the bilateral atrium. Postoperative histopathology confirmed a biatrial myxoma. The patient was discharged on the ninth day after surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Case Report: Biatrial Myxoma With Pulmonary Embolism and Cerebral Embolism: Clinical Experience and Literature Review

Ran

Chen

et al. 2022

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

show abstract

“…Surgical treatment can eliminate the early neurological symptoms caused by atrial myxoma, but it cannot ensure the nonoccurrence of delayed intracranial aneurysms. The results from chemotherapy have been equivocal (31), but evidence has shown that the combination of radiotherapy and chemotherapy is useful for the treatment of myxo ma metastasis, thereby reducing the likelihood of formation of myxomatous aneurysms (32)(33)(34). Other investigators have suggested that despite independent reports of microsurgical resection/endovascular intervention, chemotherapy, and radiotherapy for the treatment of cardiac myxomatous intracranial aneurysms, there is still a lack of clear guidelines (35).…”

Section: Discussionmentioning

confidence: 99%

Delayed multiple intracranial aneurysms caused by left atrial myxoma: a case report and literature review

Wang¹,

Wang²,

Hu³

et al. 2022

Transl Pediatr

View full text Add to dashboard Cite

Intracranial aneurysm may appear even after the removal of the cardiac myxoma. However, the pathogenesis and treatment of such aneurysm lesions are not clear. The study aimed to explore the clinical and imaging manifestation, hypothetical pathogenesis, and therapy in one case of left atrial myxoma causing multiple intracranial aneurysms. A 14-year-old male displayed a 3-hour history of episodic loss of consciousness and right hemiplegia after a leapfrog-like movement. The myxoma was diagnosed by a combination of clinical examination, leading to the diagnosis of mitral dynamic obstruction with a Grade III mitral diastolic murmur and tumor plop; magnetic resonance imaging, revealing multiple ischemic sites in both semi-oval centers; and transthoracic echocardiography, demonstrating a mitral valve obstruction.The myxoma was removed surgically; however, computed tomography angiography showed multiple intracranial aneurysms in both middle cerebral arteries 18 months after resection of the atrial myxoma. After conservative treatment, the patient had no neurological dysfunction symptoms for 5 years after myxoma resection. His condition is relatively stable. In conclusion, resection of the atrial myxoma may eliminate the early neurological symptoms, but it cannot ensure the nonoccurrence of delayed intracranial aneurysms. The neoplastic process theory was favored for explaining the aneurysm development in this case. According to the specific conditions of the patient, a combination of open surgery, chemotherapy, radiotherapy, and coil embolization is recommended.

show abstract

“…Given the poor understanding of the natural history of these lesions, a conservative management is mandatory in most asymptomatic patients with stable and nonhemorrhagic lesions. 22…”

Section: Discussionmentioning

confidence: 99%

“…Given the poor understanding of the natural history of these lesions, a conservative management is mandatory in most asymptomatic patients with stable and nonhemorrhagic lesions. 22 Follow-up imaging may show stability or even regression of some lesions after cardiac tumor removal. 20,23 In a series of 37 cases, 78.4% were managed conservatively and 75,9% with stable or even regression, with a mortality of 3.4%.…”

Section: Conservative Treatmentmentioning

confidence: 99%

Oncotic (Myxomatous) Aneurysms: A Review of Management

Peres

Brito

Peres

et al. 2022

Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery

View full text Add to dashboard Cite

Atrial myxomas are the most common primary cardiac tumors and may manifest with neurological symptoms in ∼ 30% of cases. Cerebral ischemia, aneurysmal formation, and extravascular metastases are mechanisms that lead to these neurological manifestations. Perilesional changes on computed tomography (CT) and magnetic resonance imaging (MRI) may help in the diagnosis of myxomatous aneurysms, which are usually located in the distal middle cerebral artery (MCA) and in the posterior cerebral artery (PCA) circulation territories. Careful resection of the cardiac lesion is essential for preventing embolism. However, treatment of myxomatous aneurysms is controversial due to the limited understanding of the natural history of this condition. Treatment may include clinical observation in asymptomatic patients, surgical resection, endovascular approaches, adjuvant chemotherapy, and low-dose radiation therapy. We present one case of a female patient with myxomatous aneurysm secondary to an atrial myxoma who presented with neurological symptoms and another case of a female patient who developed neurological symptoms after initial surgical treatment of the primary lesion. Lesion growth rate, topography, morphology, and the patient's clinical condition must be considered when choosing a therapeutical method. Further clinical studies are needed to achieve a better understanding and treatment of this disease.

show abstract

Cardiac Myxoma Embolization Causing Ischemic Stroke and Multiple Partially Thrombosed Cerebral Aneurysms

Cited by 20 publications

References 9 publications

Case Report: Biatrial Myxoma With Pulmonary Embolism and Cerebral Embolism: Clinical Experience and Literature Review

Case Report: Biatrial Myxoma With Pulmonary Embolism and Cerebral Embolism: Clinical Experience and Literature Review

Delayed multiple intracranial aneurysms caused by left atrial myxoma: a case report and literature review

Oncotic (Myxomatous) Aneurysms: A Review of Management

Contact Info

Product

Resources

About