A large left atrial myxoma causing multiple cerebral infarcts

Abstract

A 52-year-old man presented with a history of sudden onset diplopia. On neurological examination, the only abnormality was a right-sided oculomotor (third nerve) palsy. A brain CT was performed and reported as showing no abnormality. He was discharged to be investigated as an outpatient. He presented 1 month later with a new expressive dysphasia and confusional state. MRI was performed which revealed multiple cerebral infarcts. He was discharged on secondary stroke prevention medication. Six months elapsed, before a transthoracic echocardiogram was performed. This showed a large left atrial myxoma. The patient underwent an emergency resection and made a good postoperative recovery. This case report showed the importance of considering a cardiogenic source of emboli in patients who present with cerebral infarcts. Performing echocardiography early will help to detect treatable conditions such as atrial myxoma, and prevent further complications.

Incidental Finding of a Left Atrial Myxoma while Characterising an Autoimmune Disease

“…[2,3] Some recently published case reports have highlighted unusual or uncommon symptoms, such as arrhythmias,[4] fever of unknown origin,[5] brachial artery embolism,[6] subclavian artery embolism,[7] central retinal artery occlusion[8] and multiple cerebral infarctions. [9] These acute presentations contrast with systemic symptoms such as malaise and weight loss, as reported in recent papers. [10,11] The clinical signs and symptoms found in our patient, as well as the analytical features, led us to consider either an autoimmune disease or an occult neoplasm.…”