Transient loss of peripheral vision as the presentation of left atrial myxoma.

Abstract

affected the upper temporal quadrant of the left eye the next day. He described transient pain in his knuckles at the same time that he was aware of blurred vision. Direct questioning established a history of rheumatic fever at the age of 5 years.On examination he was an obese male Caucasian with no jaundice, cyanosis, purpuric rashes, splinter haemorrhages, or digital clubbing. His pulse was 80 and regular, and his blood pressure was 120/90 mm Hg. In addition to normal first and second heart sounds he had a harsh apical systolic murmur. All peripheral pulses were palpable and his chest was clinically clear. The central nervous system was normal. His visual acuity was 6/5 without correction in both eyes and the visual fields were full. Fundus examination showed no features of embolism or retinal ischaemia. Investigations included a chest x ray, electrocardiogram, erythrocyte sedimentation rate, full blood count, lipid profile, serum electrolytes and urea, blood cultures, and thyroid function tests, which were all normal. Urine analysis revealed blood + + + + and protein + + but midstream urine microscopy and culture were negative. Carotid Doppler echography showed a higher than normal peak systolic frequency in the left external carotid artery. His echocardiogram demonstrated a large mobile mass prolapsing through the mitral valve (Fig 1). A pedunculated cylindrical myxoma, 15 cm long, was surgically removed from the left atrium (Fig 2).Two months later the visual acuity remained normal at 6/5 in each eye. Fundus examination revealed several minute superficial retinal haemorrhages just behind the ora serrata in both eyes. A small choroidoretinal scar was identified in the mid-periphery of the retina at the 10 o'clock meridian in the right eye.

Neurological manifestations of cardiac myxoma: a review of the literature and report of cases

“…Interestingly, physical exercise can dislodge an embolus from a myxoma of the left atrium 16,44−46 . Rarer neurological presentations included spinal cord embolism and occlusion of the retinal artery from myxomatous emboli, 47−50 Parinaud's syndrome from mes­encephalic mass, confusional states, 51 behavioural disturbances and progressive dementia 52 . Psychiatric presentations of acute confusional state, chronic cognitive impairment and behavioural disturbance can pose a challenge for physicians because the underlying medical condition may be difficult to diagnose.…”