Emergency Excision of Cardiac Myxoma and Endovascular Coiling of Intracranial Aneurysm after Cerebral Infarction

Al-Said, Youssef; Al-Rached, Heyam; Baeesa, Saleh; Kurdi, Khalil; Zabani, Ibrahim; Hassan, Ahmed M.

doi:10.1155/2013/839270

Cited by 17 publications

(23 citation statements)

References 15 publications

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“…Nineteen (14.3%) patients had other than cerebral artery embolisms, with systemic multiple emboli in 4 (21.1%) [ 55 , 63 , 71 , 80 ] , peripheral multiple emboli in 3 (15.8%) [ 19 , 72 , 85 ] and solitary arterial embolus in 12 (63.2%) patients [ 9 , 11 , 13 , 16 , 21 , 35 , 41 , 43 , 60 , 76 , 84 ] . The 39 affected arteries in 18 patients were listed in Table 8 .…”

Section: Resultsmentioning

confidence: 99%

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Stroke of a cardiac myxoma origin

Yuan¹,

Humuruola²

2015

Revista Brasileira De Cirurgia Cardiovascular

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ObjectiveThe clinical features of cardiac myxoma stroke have not been sufficiently described. Debates remain concerning the options and timing of treatment and the clinical outcomes are unknown. This article aims to highlight the pertinent aspects of this rare condition.MethodsData source of the present study came from a comprehensive literature collection of cardiac myxoma stroke in PubMed, Google search engine and Highwire Press for the year range 2000-2014.ResultsYoung adults, female predominance, single cerebral vessel (mostly the middle cerebral artery), multiple territory involvements and solitary left atrial myxoma constituted the outstanding characteristics of this patient setting. The most common affected cerebral vessel (the middle cerebral artery) and areas (the basal ganglion, cerebellum and parietal and temporal regions) corresponded well to the common manifestations of this patient setting, such as conscious alteration, ataxia, hemiparesis and hemiplegia, aphasia and dysarthria. Initial computed tomography scan carried a higher false negative rate for the diagnosis of cerebral infarction than magnetic resonance imaging did. A delayed surgical resection of cardiac myxoma was associated with an increased risk of potential consequences in particular otherwise arterial embolism. The mortality rate of this patient population was 15.3%.ConclusionCardiac myxoma stroke is rare. Often does it affect young females. For an improved diagnostic accuracy, magnetic resonance imaging of the brain and echocardiography are imperative for young stroke patients in identifying the cerebral infarct and determining the stroke of a cardiac origin. Immediate thrombolytic therapy may completely resolve the cerebral stroke and improve the neurologic function of the patients. An early surgical resection of cardiac myxoma is recommended in patients with not large territory cerebral infarct.

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Section: Resultsmentioning

confidence: 99%

“…Al-Said et al. [ 11 ] disagreed the use of recombinant tissue plasminogen activator for intravenous thrombolysis due to probable myxoma source infarct. Vogel et al [ 80 ] suggested a 4-week delay of surgical resection of cardiac myxoma concerning the risk of intracerebral hemorrhage following cerebral infarction.…”

Section: Discussionmentioning

confidence: 99%

Stroke of a cardiac myxoma origin

Yuan¹,

Humuruola²

2015

Revista Brasileira De Cirurgia Cardiovascular

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“…In the current study, 1 patient presented with recurrent cerebral infarction caused by a partially thrombosed 1.7 cm myxomatous oncotic aneurysm. Previous studies have examined endovascular embolization, chemotherapy, and radiation in the treatment of such aneurysms, and the findings are equivocal (15)(16)(17)(18)(19)(20). Therefore, the optimal treatment of myxomatous oncotic aneurysms needs to be established.…”

Section: Discussionmentioning

confidence: 99%

Neurological manifestations of atrial myxoma: A retrospective analysis

Wen

Chen

et al. 2018

Oncol Lett

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Atrial myxoma is the most common type of primary cardiac tumor and it is closely associated with stroke in adults. Early diagnosis and treatment of atrial myxomas is essential for the prevention of embolic events. The aim of the present study was to assess neurological complications associated with atrial myxoma. The neurological signs of atrial myxoma were retrospectively assessed in individuals who underwent treatment at West China Hospital (Chengdu, China) and The Affiliated Hospital of Hainan Medical University (Haikou, China), between March 2003 and February 2015. A total of 130 patients with atrial myxoma were included and 22 (17%) exhibited neurologic signs. These patients were aged 39.9±12.6 years (range, 13-78 years) and there were 13 female and 9 male patients. Ischemic cerebral infarct constituted the dominant clinical symptom (68.2%) and 3 patients exhibited concomitant cardiac manifestations. Atrial myxoma was diagnosed by echocardiography in all patients. Irregular surface of atrial myxomas was associated with a high risk of embolic events. The patients with myxoma successfully underwent surgery with no mortality recorded. In conclusion, atrial myxomas frequently manifest as cerebral infarction in individuals without cardiovascular risk factors. These tumors more commonly affect the middle cerebral artery. Irregular surface of myxomas appears to be associated with embolic events. Echocardiography may improve the diagnosis and early treatment of atrial myxomas.

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“…Optimal treatment of myxomatous oncotic aneurysms has not been established. Prior studies examining the role of endovascular embolization, chemotherapy, and radiation in decreasing the growth of these aneurysms have yielded equivocal results [5,24,25] .…”

Section: Intracranial Aneurysms In Myxoma Patientsmentioning

confidence: 99%

Neuroimaging Findings in Cardiac Myxoma Patients: A Single-Center Case Series of 47 Patients

Brinjikji

Morris²,

Brown³

et al. 2015

Cerebrovasc Dis

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Background and Purpose: Cardiac myxomas can present with a myriad of neurological complications including stroke, cerebral aneurysm formation and metastatic disease. Our study had two objectives: (1) to describe the neuroimaging findings of patients with cardiac myxomas and (2) to examine the relationship between a history of embolic complications secondary to myxoma and intracranial aneurysm formation, hemorrhage and metastatic disease. We hypothesized that patients who present with embolic complications related to myxoma would be more likely to have such complications. Materials and Methods: We searched our institutional database for all patients with pathologically proven cardiac myxomas from 1995 to 2014 who received neuroimaging. Neuroimaging findings were categorized as acute ischemic stroke, intracerebral hemorrhage, oncotic aneurysm, and cerebral metastasis. Cardiac myxoma patients were divided into those presenting with embolic complications (i.e. lower extremity emboli or cerebral emboli) and those presenting with non-embolic complications prior to surgical resection of the myxoma. The prevalence of intracranial hemorrhage, myxomatous aneurysm formation, and cerebral metastases was compared in myxoma patients presenting with and without embolic complications using a Chi-squared test. Results: Forty-seven consecutive patients were included in this study. Sixteen patients (34.0%) had imaging evidence of acute ischemic stroke. Of these, 13 had acute ischemic strokes directly attributed to the cardiac myxoma (27.7%) and 3 had acute ischemic strokes secondary to causes other than myxoma (6.4%). Seven patients (14.9%) had aneurysms. Two patients (4.3%) had parenchymal metastatic disease on long-term imaging. Fourteen patients (29.8%) presented with ischemic symptoms that were attributed to cardiac myxoma (1 with lower extremity ischemia, 1 with lower extremity ischemia and ischemic stroke, and 12 with ischemic stroke). Patients presenting with embolic complications related to the myxoma (ischemic stroke or lower extremity ischemia) were more likely to have imaging evidence of intracranial hemorrhage (21.4 vs. 3.0%, p = 0.09), oncotic aneurysm (35.7 vs. 6.1%, p = 0.03), and cerebral metastasis (14.3 vs. 0.0%, p = 0.07) on follow-up imaging. Conclusions: Ischemic stroke and intracranial oncotic aneurysm were found in a substantial proportion of cardiac myxoma patients undergoing neuroimaging. Patients presenting with embolic complications of cardiac myxoma are more likely to have intracranial hemorrhage, intracranial oncotic aneurysms, and cerebral metastatic disease.

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Emergency Excision of Cardiac Myxoma and Endovascular Coiling of Intracranial Aneurysm after Cerebral Infarction

Cited by 17 publications

References 15 publications

Stroke of a cardiac myxoma origin

Stroke of a cardiac myxoma origin

Neurological manifestations of atrial myxoma: A retrospective analysis

Neuroimaging Findings in Cardiac Myxoma Patients: A Single-Center Case Series of 47 Patients

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