An unusual case of focal epilepsy

Balasuriya, B M A C; Wijesekara, Jagath C; Perera, S.

doi:10.4038/cmj.v50i1.1589

Cited by 2 publications

(2 citation statements)

References 4 publications

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“…Although the mechanisms of embolization of a benign tumor and metastasis of an invasive malignancy are fundamentally different, the appearance of multiple lesions at a distant site in the setting of a cardiac myxoma has occasionally been referred to (erroneously) in the literature as “metastasis.” 17,18 Since the first description made by Rankin et al ., in 1978, 19 our comprehensive review revealed 36 histologically established cases of intracerebral embolization associated with parenchymal brain invasion from a benign left atrial myxoma (Table 1). 10,14,18–51 A careful review of the cases confirmed that three patients have been reported twice, 14,19,20,23,24,28 six patients had unavailable histological proof, 37,52–56 and four apparent primary cardiac sarcomas were erroneously reported as a cardiac myxoma 57–60 . In one case, the original report could not be located, 61 and another report described embolic myxoma cells in the leptomeninges without evidence of parenchymal seeding 62 …”

Section: Discussionmentioning

confidence: 96%

Cerebral embolization associated with parenchymal seeding of the left atrial myxoma: Potential role of interleukin‐6 and matrix metalloproteinases

et al. 2020

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Systemic embolization has been reported in up to 40% of patients with left atrial myxoma, half of them with cerebral involvement. However, development of intracerebral embolization associated with parenchymal seeding of the myxoma emboli is an extremely rare complication, with only 36 histologically diagnosed cases reported in the published literature. We describe a 69-year-old woman who arrived at the emergency service with hemiparesis associated with drug-resistant epilepsy and a medical history of resection of a left atrial myxoma 10 months previously. Cranial computed tomography revealed multiple large lesions of heterogeneous density and cystic components in the occipital lobes and posterior fossa parenchyma. Histopathological analyses after stereotactic biopsy of the occipital lesion revealed infiltrative myxoma cells with benign histological findings and uniform expression of calretinin similar to that of the primary cardiac myxoma. Additional immunohistochemical studies confirmed brain parenchymal seeding of the myxoma cells with strong expression of interleukin-6 (IL-6) and focal expression of matrix metalloproteinases-2 (MMP-2). Here, we discuss the clinicopathological features of intracerebral embolization of left atrial myxomas associated with progressive parenchymal seeding of the tumor emboli and the potential pathogenic role of IL-6 and MMPs.

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Section: Discussionmentioning

confidence: 96%

Cerebral embolization associated with parenchymal seeding of the left atrial myxoma: Potential role of interleukin‐6 and matrix metalloproteinases

et al. 2020

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“…The shedding particles of myxoma may cause embolic occlusion of intracranial vessels, weaken arterial walls, and penetrate the damaged endothelium, causing aneurysmal dilation. Additionally, some myxoma particles may form metastatic sites ( 19 ). Metastatic lesions can be found in rare cases, even after a cardiac myxoma has been removed entirely because metastatic seeding prior to surgery may give rise to lesions at distant sites ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

Case report: Multiple brain metastases of atrial myxoma: Clinical experience and literature review

Zhao²,

Li³

et al. 2023

Front. Neurol.

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Myxoma is the most common type of benign cardiac tumor in adults, and it has a strong tendency to embolize or metastasize to distant organs. Patients with multiple brain metastases have rarely been seen in clinics; hence, standard treatment protocols for multimyxoma metastasis in the brain have not been established. We present the case of a 47-year-old female who had convulsions in the right hand and repeated seizures. Computed tomography revealed multiple tumor sites in her brain. Craniotomy was conducted to remove the tumor sites. However, recurrent brain tumors and unexpected cerebral infarctions occurred frequently shortly after the treatment because the cardiac myxoma had not been treated due to the patient's personal concerns. The myxoma was resected by gamma knife radiosurgery, and temozolomide was given prior to cardiac surgery. There has been no evidence of tumor recurrence from the 2 years following the surgery until the present. This case highlights the importance of prioritizing cardiac lesions over cerebral lesions; if a cerebral metastasis has been found, it is likely that the cardiac myxoma is already unstable, with high rates of spread and metastasis. Therefore, it is unwise to treat metastasis sites before the cardiac myxoma. Additionally, the case suggests that gamma knife radiosurgery combined with temozolomide is effective as treatment for multiple myxoma metastasis in the brain. Compared with conventional cerebral surgery, gamma knife radiosurgery is safer, causes less bleeding, and requires a shorter time for recovery.

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An unusual case of focal epilepsy

Cited by 2 publications

References 4 publications

Cerebral embolization associated with parenchymal seeding of the left atrial myxoma: Potential role of interleukin‐6 and matrix metalloproteinases

Cerebral embolization associated with parenchymal seeding of the left atrial myxoma: Potential role of interleukin‐6 and matrix metalloproteinases

Case report: Multiple brain metastases of atrial myxoma: Clinical experience and literature review

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