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

Abstract

J Korean Neurosurg Soc 45 : [394][395][396] 2009 Cerebral embolic infarction is the most common neurologic complication of cardiac myxoma (CM). Development of cerebral aneurysms in CM is very rare. We present a 64-year-old woman with acute cerebral infarction and multiple cerebral aneurysms complicated by CM. The aneurysms were multiple, fusiform-shaped, and located in distal branch of major cerebral arteries. The serum interleukin (IL)-6 was highly elevated, which was normalized after surgical resection of CM. There was no regression of aneurysms on follow-up neuroimaging. Multiple cerebral aneurysms in CM are rare condition. Highly elevated serum IL-6 may be associated with increased risk of cerebral aneurysmal formation.

Intracardiac Myxoma, Cerebral Aneurysms and Elevated Interleukin-6

“…Even though embolism of myxoma is a documented contributor to initial aneurysm formation, it is possible that subsequent aneurysms may only require endocrine signals originating from other cerebral aneurysms to grow. If this is true, elevated IL-6 levels may have a stronger correlation with future aneurysm formation than detected tumor embolization [ 12 , 13 , 14 ]. Cardiac myxoma resection is usually accompanied by a reduction in serum IL-6 levels.…”

Multiple Cerebral and Systemic Aneurysms in a Case of Left Atrial Myxoma – Are They Related?

“…IL-6 is a cytokine which causes differentiation & proliferation of cells along with overexpression of several proteolytic enzymes that degrade extracellular matrix (ECM), promoting fragmentation of tumor and acceleration of embolic event. Formation of cerebral aneurysm may be related to overproduction of IL-6 by tumor emboli causing degradation of ECM in cerebral vessels [19][20][21].…”

Coil embolization of an enlarging fusiform myxomatous cerebral aneurysm

“…Other authors have proposed aneurysm formation is secondary to a reaction to secretion of a proinflammatory cytokine, interleukin-6 (IL-6), by myxoma cells [4] , [8] . Studies have shown atrial myxoma cells are capable of producing IL-6 [9] , [10] , and elevated IL-6 levels have been detected in patients with intracranial myxomatous aneurysms, both before and after myxoma resection [4] , [8] , [9] , [11] . Although the exact mechanism of aneurysm induction by IL-6 has not been elucidated, it has been proposed that IL-6 induces overexpression of multiple proteolytic enzymes, which can degrade the extracellular matrix of myxoma cells and encourage embolization to the cerebral vessels [9] , [12] .…”

“…Studies have shown atrial myxoma cells are capable of producing IL-6 [9] , [10] , and elevated IL-6 levels have been detected in patients with intracranial myxomatous aneurysms, both before and after myxoma resection [4] , [8] , [9] , [11] . Although the exact mechanism of aneurysm induction by IL-6 has not been elucidated, it has been proposed that IL-6 induces overexpression of multiple proteolytic enzymes, which can degrade the extracellular matrix of myxoma cells and encourage embolization to the cerebral vessels [9] , [12] . It has also been suggested that these embolized myxomatous cells continue to produce IL-6, directing weakening cerebral vessel walls and leading to aneurysm formation [9] , [11] .…”