Stroke of a cardiac myxoma origin

Abstract

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.

Mechanical thrombectomy in cardiac myxoma stroke: a case report and review of the literature

“…The classic symptom triad of cardiac myxoma includes cardiac symptoms related to mitral valve obstruction, systemic embolization (peripheral or cerebral) and constitutional symptoms. Diagnosis of cardiac myxoma is often elusive and frequently detected after a stroke as the first event [3,17]. Echocardiography proved to be readily available and a definite diagnostic modality for identifying cardiac myxoma [5].…”

“…It seems to be important to find early diagnostic clue and immediately follow echocardiography for definite diagnosis. It is also recommended bedside echocardiography routinely to avoid delayed diagnosis in young stroke patients [13,17]. The estimated incidence of myxomarelated stroke ranged from 10 to 30 % of patients [7,9].…”

“…Despite the benign nature of this tumor, it has a high risk of cerebral infarction, and frequently delayed diagnosis until after the stroke [3,17]. Recent development of endovascular devices enables safe and effective treatment of acute ischemic stroke (AIS) [11].…”

Tandem cervical/intracranial internal carotid artery occlusion due to cardiac myxoma treated successfully with mechanical endovascular thrombectomy

“…The cerebral artery most commonly affected by ischemic stroke due to cardiac myxoma is the MCA (65 %) [12]. ICA involvement by embolic occlusion due to cardiac myxoma is relatively rare (11 %) [12], and cervical ICA occlusion due to cardiac myxoma even rarer.…”

Cardiogenic Embolism due to Left Atrial Myxoma Successfully Treated by ADAPT: A Case Report

“…9) Cerebral embolism due to left atrial myxoma is characterized by simultaneous occlusion of multiple blood vessels, and simultaneous occlusion of multiple major arteries was observed in 27.3% (3/11) of the cases listed in Table 1. 15) If multiple vessels are occluded simultaneously, deployment of multiple stent retrievers is required, which increases the risk of hemorrhagic complications due to vascular damage. The above patient who developed subarachnoid hemorrhage underwent a total of six stent deployments at three sites of occlusion.…”