Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: a case report and review

Abstract

Left cardiac myxoma and also consecutive embolization into the brain is well documented, whereas the association of myxomas with multiple fusiform cerebral aneurysms is rare. We analyze 33 previously reported patients and present a case of a 43-year-old woman with multiple cerebral infarctions 2 years after resection of a recurrent myxoma in the left atrium. Cerebral angiography displayed multiple fusiform aneurysms of several cerebral arteries, including a giant aneurysm of the basilar artery. Serum level of interleukin-6 (IL-6) was highly elevated. The clinical, radiological and pathological features of these aneurysms are summarized. The pathogenesis, including the role of IL-6 in the formation of myxomatous aneurysms, is discussed.

Multiple Fusiform Cerebral Aneurysms and Highly Elevated Serum Interleukin-6 in Cardiac Myxoma

“…Sequential angiographic study in some patients revealed that the time course of aneurysm formation and growth is highly variable. No further growth of aneurysms after cardiac surgery was reported in several cases including our case, but persistent growth of aneurysm despite successful removal of CM was also reported in a few cases 7) . This suggests that surgical resection of primary CM cannot completely abolish the risk of delayed cerebral aneurysm formation in some cases, because of preceding intracranial metastasis of myxomatous cell before surgery.…”

“…Only one case (1.4%) had concurrent cerebral aneurysm in addition to embolic infarction, indicating that development of cerebral aneurysms in CM a rare. In meta-analysis of 34 reported cases with cerebral aneurysm associated with CM, 7) cerebral aneurysms were usually multiple (median number of aneurysm=3), were of fusiformshaped (91%), and were located in distal branches of both sides of middle cerebral artery (74%). Cardiac and constitutional manifestation was found in 40% and 25% of cases, respectively.…”

“…The characteristic symptoms of CM are cardiac (dyspnea, syncope), constitutional (fever, weight loss) and neurological manifestation. Systemic embolism has been reported in 30-50% of patients, half of which had cerebral infarction 7) . The CM is a major cardioembolic source of ischemic stroke.…”

Effective Intravenous Thrombolytic Therapy in a Patient with Cerebral Infarction Associated with Left Atrial Myxoma

“…It can embolize to any organs, and patients with various symptoms of cerebral infarction have been reported (2)(3)(4). The embolic source may be composed of tumor itself or thrombus (5).…”

“…However, the guidelines do not discuss stroke with myxoma (7)(8)(9), and only a small number of cases have been reported (10)(11)(12)(13)(14)(15)(16)(17). Myxoma may also cause cerebral aneurysm formation (3,4), and there is a risk of cerebral hemorrhage with thrombolytic therapy. Therefore, thrombolytic therapy in cerebral infarction with myxoma is still controversial.…”