Heart or head?: A depression mimic delays diagnosis—oncotic cerebral aneurysms caused by atrial myxoma

Abstract

Complications of intracardiac tumours can carry significant morbidity and mortality. This article depicts the case of a female who presented with multiple oncotic intracranial aneurysms secondary to a left atrial myxoma. The clinical manifestations and pathogenesis of cardiac myxoma, as well as the imaging pathway, management and prognosis of myxomatous aneurysms will be discussed. Excision of the cardiac mass is mandatory both for symptomatic improvement and to prevent further embolic complications. Local recurrence and delayed onset cerebral complications do occur, and necessitate ongoing patient follow-up. Our report highlights several important features of the diagnostic and treatment pathway for atrial myxoma—in particular, the potentially non-specific clinical presentation, the pivotal role of cardiac MRI in the multimodality diagnostic imaging work up and the need for multidisciplinary communication to identify the diagnosis and guide appropriate management.

Multiple cerebral metastases and metastatic aneurysms in patients with left atrial Myxoma: a case report

“…Imaging studies as CT, MRI and cerebral angiography should be performed in every patient with atrial myxoma to detect aneurysms and cerebral lesion. The echocardiography is also suggested for every patient presenting a cerebral infarction with aneurysm [12].…”

“…Furthermore, it is noted that most of the aneurysms are fusiform in shape, and clipping or coiling treatment can be limited. Though there are successful cases of endovascular coiling for enlarging aneurysms, overall evidence documenting stability of cerebral aneurysms over several years gives support to conservative treatment management options [12, 23–25].…”