Central Nervous System Manifestations of Cardiac Myxoma

Abstract

Background: Neurologic complications can be the initial manifestation of atrial myxoma. Prompt diagnosis is of paramount significance to prevent recurrent complications. Objective: To identify patients with neurologic complications attributed to atrial myxoma. Design, Setting, and Patients: With institutional review board approval, we retrospectively reviewed the medical records of 74 consecutive patients with pathologically confirmed cardiac myxoma at the Mayo Clinic from January 1, 1993, through December 31, 2004. Main Outcome Measures: Discharge and follow-up modified Rankin score. Results: Nine of the 74 patients with cardiac myxoma (12%) presented with neurologic manifestations in the setting of atrial myxoma. Mean age was 48.5 years (range, 17-70 years). There were 6 females and 3 males. Among patients with myxoma and neurologic symptoms, ischemic cerebral infarct was the most common neurologic manifestation (8 patients [89%]). No patients had con-comitant cardiac symptoms. The size of the atrial myxoma was variable, with a mean diameter of 2.7 (range, 0.4-6.5) cm. Most of the atrial myxomas causing neurologic symptoms demonstrated a mobile component on transesophageal echocardiography (8 patients [89%]). Two patients (22%) had pathologic evidence of systemic myxomatous emboli. One patient with intracerebral hemorrhage had pathologically confirmed intracranial metastatic myxoma and myxoma-induced aneurysmal dilatation. Conclusions: Neurologic complications are associated with cardiac myxoma in some patients with myxoma and, when they occur, frequently present with cerebral infarction. The mobility, not the size, of the myxoma appears to be related to embolic potential. Potential delayed neurologic complications relevant to patients with tumor embolization include myxoma-induced cerebral aneurysm and myxomatous metastasis, which can mimic the clinical picture of central nervous system vasculitis or infective endocarditis.

Eleven Years’ Experience with Korean Cardiac Myxoma Patients: Focus on Embolic Complications

“…The incidence is similar to that reported in previous studies, ranging from 1 to 3% [7,12]. Similar to the aneurysms related to septic emboli, myxomatous aneurysms are usually fusiform and frequently occur at multiple sites along the distal cerebral arteries [6,7,12,27]. Similarly, our case showed multiple fusiform aneurysms with a peripheral distribution.…”

“…Tumor resection is curative in most patients, and recurrent embolism after tumor removal is rare [6,7,8,9]. Similar to previous series, there was no recurrence of embolism or other myxoma-related symptoms during the follow-up period.…”

Eleven Years’ Experience with Korean Cardiac Myxoma Patients: Focus on Embolic Complications

“…The incidence is similar to that reported in previous studies, ranging from 1 to 3% [7,12]. Similar to the aneurysms related to septic emboli, myxomatous aneurysms are usually fusiform and frequently occur at multiple sites along the distal cerebral arteries [6,7,12,27]. Similarly, our case showed multiple fusiform aneurysms with a peripheral distribution.…”

“…Tumor resection is curative in most patients, and recurrent embolism after tumor removal is rare [6,7,8,9]. Similar to previous series, there was no recurrence of embolism or other myxoma-related symptoms during the follow-up period.…”

The imaging features of neurologic complications of left atrial myxomas

“…Similar results were obtained in the Mayo clinic series where out of the 74 patients, in 9 (12%) neurological symptoms were the initial presenting feature [6]. The common neurologic complications are cerebral infarction due to thromboembolism.…”

Life-Threatening Conditions and Preoperative Complications Associated with Cardiac Neoplasm Do Not Affect Surgical Outcomes or Mortality

“…Myxoma, which is the most common cardiac neoplasm, often presents with heart failure, followed by embolic symptoms. According to previous reports on myxoma, embolism in cases with myxoma is 21-89% CI and 13-29% other embolization [17][18][19], and embolization is more common in patients with echocardiographic mobility and gross papillary [19,20]. This finding is in accordance with that of the current study, which included 19 patients with myxoma in the left atrium.…”

Eleven Years’ Experience with Korean Cardiac Myxoma Patients: Focus on Embolic Complications

“…The incidence is similar to that reported in previous studies, ranging from 1 to 3% [7,12]. Similar to the aneurysms related to septic emboli, myxomatous aneurysms are usually fusiform and frequently occur at multiple sites along the distal cerebral arteries [6,7,12,27]. Similarly, our case showed multiple fusiform aneurysms with a peripheral distribution.…”

“…Tumor resection is curative in most patients, and recurrent embolism after tumor removal is rare [6,7,8,9]. Similar to previous series, there was no recurrence of embolism or other myxoma-related symptoms during the follow-up period.…”

The imaging features of neurologic complications of left atrial myxomas

“…Similar results were obtained in the Mayo clinic series where out of the 74 patients, in 9 (12%) neurological symptoms were the initial presenting feature [6]. The common neurologic complications are cerebral infarction due to thromboembolism.…”

Life-Threatening Conditions and Preoperative Complications Associated with Cardiac Neoplasm Do Not Affect Surgical Outcomes or Mortality

“…Myxoma, which is the most common cardiac neoplasm, often presents with heart failure, followed by embolic symptoms. According to previous reports on myxoma, embolism in cases with myxoma is 21-89% CI and 13-29% other embolization [17][18][19], and embolization is more common in patients with echocardiographic mobility and gross papillary [19,20]. This finding is in accordance with that of the current study, which included 19 patients with myxoma in the left atrium.…”

Eleven Years’ Experience with Korean Cardiac Myxoma Patients: Focus on Embolic Complications

“…The incidence is similar to that reported in previous studies, ranging from 1 to 3% [7,12]. Similar to the aneurysms related to septic emboli, myxomatous aneurysms are usually fusiform and frequently occur at multiple sites along the distal cerebral arteries [6,7,12,27]. Similarly, our case showed multiple fusiform aneurysms with a peripheral distribution.…”

“…Tumor resection is curative in most patients, and recurrent embolism after tumor removal is rare [6,7,8,9]. Similar to previous series, there was no recurrence of embolism or other myxoma-related symptoms during the follow-up period.…”

The imaging features of neurologic complications of left atrial myxomas

“…Similar results were obtained in the Mayo clinic series where out of the 74 patients, in 9 (12%) neurological symptoms were the initial presenting feature [6]. The common neurologic complications are cerebral infarction due to thromboembolism.…”

Life-Threatening Conditions and Preoperative Complications Associated with Cardiac Neoplasm Do Not Affect Surgical Outcomes or Mortality

“…Myxoma, which is the most common cardiac neoplasm, often presents with heart failure, followed by embolic symptoms. According to previous reports on myxoma, embolism in cases with myxoma is 21-89% CI and 13-29% other embolization [17][18][19], and embolization is more common in patients with echocardiographic mobility and gross papillary [19,20]. This finding is in accordance with that of the current study, which included 19 patients with myxoma in the left atrium.…”