Neurological manifestations of atrial myxoma: A retrospective analysis

Abstract

Atrial myxoma is the most common type of primary cardiac tumor and it is closely associated with stroke in adults. Early diagnosis and treatment of atrial myxomas is essential for the prevention of embolic events. The aim of the present study was to assess neurological complications associated with atrial myxoma. The neurological signs of atrial myxoma were retrospectively assessed in individuals who underwent treatment at West China Hospital (Chengdu, China) and The Affiliated Hospital of Hainan Medical University (Haikou, China), between March 2003 and February 2015. A total of 130 patients with atrial myxoma were included and 22 (17%) exhibited neurologic signs. These patients were aged 39.9±12.6 years (range, 13-78 years) and there were 13 female and 9 male patients. Ischemic cerebral infarct constituted the dominant clinical symptom (68.2%) and 3 patients exhibited concomitant cardiac manifestations. Atrial myxoma was diagnosed by echocardiography in all patients. Irregular surface of atrial myxomas was associated with a high risk of embolic events. The patients with myxoma successfully underwent surgery with no mortality recorded. In conclusion, atrial myxomas frequently manifest as cerebral infarction in individuals without cardiovascular risk factors. These tumors more commonly affect the middle cerebral artery. Irregular surface of myxomas appears to be associated with embolic events. Echocardiography may improve the diagnosis and early treatment of atrial myxomas.

Pearls & Oy-sters: IV and mechanical thrombolysis for ischemic stroke secondary to cardiac myxoma

“…Primary tumors of the heart are rare, with an incidence of 0.0017%-0.19% at autopsy, with atrial myxomas being the most common, comprising up to 80% of primary heart tumors. 1,2 Cardiac myxomas occur most commonly in the third to sixth decades of life but can occur at any age and are more common in female patients in a >2:1 ratio. [1][2][3][4] Most cardiac myxomas (75%) originate from the left atrium and less commonly are found in the right atrium, bilateral atria, heart valves, and only 3%-4% detected in either ventricle.…”

“…1,4 Myxoma characteristics including mobility, size, location, and type are associated with likelihood of embolism. [1][2][3] The consistency of the myxoma determines its mobility, with villous extensions being fragile with greater tendency to fragment and embolize. 1,4 Systemic emboli occur in 30%-50% of patients with myxoma with over 50% of emboli going to the CNS and retinal arteries.…”

“…1,4 Systemic emboli occur in 30%-50% of patients with myxoma with over 50% of emboli going to the CNS and retinal arteries. [2][3][4] Cardiac myxomas are the cause of <1% of ischemic strokes. 5,6 Hemorrhagic stroke is less common and is related to the formation of cerebral aneurysms.…”

“…5,6 Hemorrhagic stroke is less common and is related to the formation of cerebral aneurysms. 2 Aneurysm formation occurs when myxoma embolization leads to infiltration of a vessel wall by the embolus causing weakening of the vessel wall. 2,7 Studies of stroke secondary to cardiac myxoma are largely limited to case reports and small series.…”

“…2 Aneurysm formation occurs when myxoma embolization leads to infiltration of a vessel wall by the embolus causing weakening of the vessel wall. 2,7 Studies of stroke secondary to cardiac myxoma are largely limited to case reports and small series. A 2015 comprehensive literature collection of stroke of cardiac myxoma origin described the features of this rare condition from cases of 133 patients between 2000 and 2014.…”