Rupture of Cerebral Myxomatous Aneurysm Months After Resection of the Primary Cardiac Tumor

Abstract

Myxomatous aneurysms are important entities for neurointensivists to recognize and can present years after diagnosis. Patients presenting with cerebral infarction or hemorrhage of unknown etiology should undergo cardiac imaging to rule out atrial myxoma, as up to 50% of patients with myxomas present initially with stroke.

“Metastatic” embolic lesions and enlarging pseudoaneurysms associated with cardiac myxoma

“…3 Further transgression of myxoma cells through the vessel wall may lead to chronic recurrent bleeding and/or formation of the "metastatic" masses that are typically situated in the areas of prior embolism. 1 "Metastatic" masses may persist after surgical resection of the primary cardiac myxoma.…”

“…7 Surgical removal of parenchymal lesions is suggested in cases of an isolated lesion with easy surgical access, symptomatic intracranial bleeding or mass effect, or when no clear diagnosis is available. 3,4,7 Due to the number of lesions and their friable nature, microsurgical clipping of pseudoaneurysms is of unclear benefit and not without risks. 3,7 In case of pseudoaneurysm rupture, surgical evacuation of the hematoma with clip ligation of the lesions has been described.…”

“…3,4,7 Due to the number of lesions and their friable nature, microsurgical clipping of pseudoaneurysms is of unclear benefit and not without risks. 3,7 In case of pseudoaneurysm rupture, surgical evacuation of the hematoma with clip ligation of the lesions has been described. 3 Our case illustrates a rare and long-standing neurologic complication from a cardiac myxoma.…”

“…3,7 In case of pseudoaneurysm rupture, surgical evacuation of the hematoma with clip ligation of the lesions has been described. 3 Our case illustrates a rare and long-standing neurologic complication from a cardiac myxoma. After the presenting cerebral ischemic events and following surgical resection of the cardiac tumor, pseudoaneurysms and "metastatic" masses developed and continued to progress over months despite minimal clinical compromise.…”

Cardiac myxomas and their surgical results

“…Serebral arterlerdeki hemoraji ve anevrizma özellikle sol atriyum içinde büyüyen miksoma ile ilişkilidir. [11,12] Etyolojisi bilinmeyen serebral iskemi ya da hemoraji bulunan hastalarda atriyal miksoma açısından kardiyak görün-tüleme yapılmalıdır. Cerrahi sonrası ortaya çıkabi-lecek nörolojik sorunlar çoğu zaman sekel bırakma-makla birlikte partikül veya hava embolileri açısından dikkatli olunması gerekmektedir.…”