CNS Embolism due to Atrial Myxoma

Sandok, Burton A.

doi:10.1001/archneur.1980.00500570033004

Cited by 67 publications

(8 citation statements)

References 31 publications

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“…Embolic events occurred in 22% of our patients and have been reported in 6–45% of cases elsewhere [5,11,12,17,18]. Neurologic symptoms occurred in 20.3% of our cases, which is within the range of 12–45% reported in previous studies [5,6,7,12].…”

Section: Discussionsupporting

confidence: 80%

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Eleven Years’ Experience with Korean Cardiac Myxoma Patients: Focus on Embolic Complications

Lee¹,

Kim

et al. 2012

Cerebrovasc Dis

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Background: Cardiac myxomas are rare but are the most common cardiac tumors. This study is based on our clinical experience with cardiac myxomas over a period of 11 years at Sejong General Hospital. We focused on the embolic complications of patients with cardiac myxoma. Methods: We retrospectively reviewed the medical records of 59 consecutive patients with cardiac myxoma who were treated between January 2000 and March 2011. The myxomas were divided into two types: type 1, with an irregular or villous surface and a soft consistency, and type 2, with a smooth surface and a compact consistency. The 59 investigated patients were classified into the embolic group and the non-embolic group. Results: Cardiac obstructive symptoms, embolic events and constitutional symptoms were observed in 37 (62.7%), 13 (22.0%) and 10 (16.9%) patients, respectively. When the embolic and non-embolic groups were compared, there were no significant differences in vascular risk factors, the ejection fraction, the left atrial diameter or the tumor size. However, type 1 myxomas were significantly more frequent in the embolic group (p = 0.009 by Fisher’s exact test). A binary logistic regression analysis showed that type 1 pathology alone was independently associated with myxoma-related embolism (p = 0.008; odds ratio 10.056; 95% confidence interval 1.828–55.337). There were no operative deaths in any of the 59 patients studied. Among the 13 patients with embolism, 11 (84.6%) had brain infarcts. The main patterns of the lesions were multiple lesions (8 out of 11 patients, 72.7%) and lesions in the middle cerebral artery territories (7 out of 11 patients, 63.6%). The other 2 patients were found to have occlusion of the left central retinal artery and left external iliac artery. Additionally, incidental cerebral aneurysms were found in the latter case. There was no recurrence of myxoma or myxoma-related symptoms in the 53 patients receiving outpatient management during the follow-up period (range 2 months to 11 years). Conclusions: The embolic potential of myxoma was associated with an irregular surface pathology but not with vascular risk factors. Echocardiography should be performed in patients with embolic events, especially when cerebral infarcts with multiple territorial lesions are detected. Surgical resection is a relatively safe and curative procedure for cardiac myxoma.

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Section: Discussionsupporting

confidence: 80%

“…Occasionally, cardiac myxoma may manifest as a systemic or cerebral embolic event. The neurological symptoms related to myxoma usually consist of embolic brain infarcts [5,6,7]. If the tumor is not surgically removed, myxoma-related embolism may recur [8,9].…”

Section: Introductionmentioning

confidence: 99%

Eleven Years’ Experience with Korean Cardiac Myxoma Patients: Focus on Embolic Complications

Lee¹,

Kim

et al. 2012

Cerebrovasc Dis

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“…Heart signs and symptoms may undergo an important improvement after embolisation [10, 14]. In more than a half of the cases, the embolic event affects the CNS [9, 15], which occurred in our series in 82% of patients with embolic phenomena. Cerebral infarcts, TIA, amaurosis, and less frequently medullary infarcts [16]may be the clinical symptom.…”

Section: Discussionmentioning

confidence: 84%

“…Furthermore, blood flow obstruction may cause syncope and sudden death. It is usually said that auscultatory findings change with the position of the patient, but this is rarely found in clinical practice [9, 10]. …”

Section: Discussionmentioning

confidence: 99%

Transient Ischaemic Attack: A Common Initial Manifestation of Cardiac Myxomas

Álvarez-Sabín¹,

Lozano²,

Sastre‐Garriga³

et al. 2001

Eur Neurol

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Background and Aims: Cardiac myxomas may present clinically with many different features. Since highly effective treatments exist, it is important that they are diagnosed quickly in order to avoid further complications. Our aim was to determine the influence of neurological presentation in diagnosis and prognosis of cardiac myxomas. Methods: We have reviewed the clinical charts of 28 patients diagnosed with cardiac myxomas seen at our centre in the last 20 years. Results: Mean age at diagnosis in patients with neurological events was 49.22 years and 60.84 years in those without neurological manifestations (p = 0.0325). Most frequent presentations were: cardiac manifestations (92.8%), general manifestations (71.4%) and embolic events (39.3%). Nine patients (32.1%) presented with cerebral embolism; 7 of whom presented with transient ischaemic attacks (TIA), which was the first manifestation in 6 of them; 3 of them later suffered complete cerebral infarction with sequelae. Echocardiography confirmed diagnosis in 26 out of 27 patients in which it was performed. None of the patients presented neurological symptoms after surgery. Conclusion: The most frequent initial neurological manifestation in our series was TIA. Nevertheless, none of the patients were diagnosed after the first neurological symptom. Although the contribution of cardiac myxomas to the total amount of TIA is low, since surgery is highly effective and of low risk, and patients with neurological manifestations are younger, it is vital to consider the possibility of cardiac myxoma after a TIA of unknown origin.

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“…However, large case studies of patients with cardiac myxoma-related CNS embolism have not been published, although a few previous series have been reported [11–15]. Neurologic manifestations of atrial myxomas have been reported in 12% to 45% of affected patients [6, 8, 9, 11, 13, 14] and were quite various. The neurologic signs and symptoms are usually a result of emboli from a myxomatous or tumour-adherent thrombus.…”

Section: Introductionmentioning

confidence: 99%

Brain Embolism Secondary to Cardiac Myxoma in Fifteen Chinese Patients

Long

Gao

2014

The Scientific World Journal

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Background. Heart myxoma-related embolisms commonly involve the central nervous system, but data are lacking in Chinese patients. Methods. 27 patients diagnosed with myxoma were reviewed retrospectively. Results. Among 27 patients, fourteen (51.9%) patients were women. Fifteen (55.6%) patients had brain embolisms. Rarely, patients were misdiagnosed with central nervous system vasculitis (n = 2), moyamoya disease (n = 1), and neuromyelitis optica (n = 1). We found positive associations between mRS (>3) and female gender (r = 0.873, P < 0.0001), infection (r = 0.722, P = 0.002), severe complications (r = 0.722, P = 0.002), systolic blood pressure (SBP) of <120 mmHg (r = 0.6, P = 0.018), WBC count of >10 × 109/L (r = 0.722, P = 0.002), tumour size (r = 0.866, P < 0.0001), bilateral brain lesions (r = 0.60, P = 0.018), and total anterior circulation infarction (TACI) (r = 0.667, P = 0.007). The independent relationships among these factors and outcomes could not be confirmed (P > 0.05). Conclusions. Neurologic manifestations in Chinese patients with cardiac myxoma-related stroke were complicated and multifarious. Female gender, infection, other severe complications, low SBP, tumour size, bilateral brain lesions, TACI, and high WBC counts could be associated with a poor prognosis.

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CNS Embolism due to Atrial Myxoma

Cited by 67 publications

References 31 publications

Eleven Years’ Experience with Korean Cardiac Myxoma Patients: Focus on Embolic Complications

Eleven Years’ Experience with Korean Cardiac Myxoma Patients: Focus on Embolic Complications

Transient Ischaemic Attack: A Common Initial Manifestation of Cardiac Myxomas

Brain Embolism Secondary to Cardiac Myxoma in Fifteen Chinese Patients

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