Neurological complication related to atrial myxomas

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Abstract

Objectives

Atrial myxoma is a rare neoplasm that accounts for approximately 50% of primary cardiac tumours. Neurological complications of atrial myxoma include stroke from tumour embolization and aneurysm formation. The pathogenesis of aneurysm formation is unclear. We present a patient whose myxoma was diagnosed following an embolic stroke and who was then diagnosed with the typical cerebral aneurysms related to the tumour.

Case

A 62 year old woman presented with left facial weakness and dysarthria. Physical examination confirmed the dysarthria and an upper motor neurone pattern of facial weakness. A non-contrast CT brain demonstrated an evolving ischaemic infarction in the right frontal lobe. Transthoracic echocardiography demonstrated an atrial myxoma, which was resected. Her husband reported she had mild cognitive changes and problems with mobility at a four-month follow-up. MRI brain at that point revealed multifocal aneurysmal dilatation of pial vessels, in addition to evidence of previous infarction and leptomeningeal siderosis from prior small SAH. Digital subtraction angiography revealed fusiform aneurysms associated with atrial myxoma

Conclusions

This case highlights both the recognised neurologic complications of atrial myxoma in a single patient and presents the characteristic angiographic findings. The diagnosis of cerebral aneurysms can be delayed up to five years1. Evaluation should therefore be considered following a histologic diagnosis of atrial myxoma.

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