Cardiac myxoma presenting with sensory neuropathy

Cardiac Myxomas As Chameleons: A Scoping Review of Their Paraneoplastic Presentations

This scoping review aims to explore the relationship between cardiac myxomas (CMs) and paraneoplastic syndromes (PS). CMs are the most common tumors in the heart, with the majority located in the left atrium, and are often associated with a triad of obstructive, embolic, and constitutional symptoms. However, they can also present with unrelated symptoms that are part of a PS. This study performed a thorough literature search of 11 databases and included 12 papers in the final review. All of the patients were diagnosed with atrial myxoma, which initially presented as a PS. Surgery was the curative measure in all cases and resulted in remission in every case, with patients reporting resolution of symptoms at follow-up. The majority of patients in the study were female, with comorbid rheumatologic conditions often present. This study highlights the heterogeneity of presentations of CMs and their associated PS.

Pain as a First Manifestation of Paraneoplastic Neuropathies: A Systematic Review and Meta-Analysis

INTRODUCTION

Paraneoplastic neurological syndromes (PNS) consist of a heterogeneous group of neurological disorders triggered by cancer. The aim of this systematic review is to estimate the reported prevalence of pain in patients with paraneoplastic peripheral neuropathy (PPN).

METHODS

A systematic computer-based literature search was conducted on PubMed database.

RESULTS

Our search strategy resulted in the identification of 126 articles. After the eligibility assessment, 45 papers met the inclusion criteria. Full clinical and neurophysiological data were further extracted and involved 92 patients with PPN (54.5% males, mean age 60.0 ± 12.2 years). The commonest first manifestation of PPN is sensory loss (67.4%), followed by pain (41.3%), weakness (22.8%), and sensory ataxia (20.7%). In 13.0% of the cases, pain was the sole first manifestation of the PPN. During the course of the PPN, 57.6% of the patients may experience pain secondary to the neuropathy.

CONCLUSIONS

Pain is very prevalent within PPN. Pain specialists should be aware of this. Detailed history-taking, full clinical examination, and requesting nerve conduction studies might lead to an earlier diagnosis of an underlying malignancy.

Painful multiple mononeuropathy as a first symptom of cardiac myxoma: an unusual clinical presentation

BACKGROUND

Atrial myxoma (AM) is responsible for multiple serious complications, such as ischemic stroke, and requires cardiac surgery. However, diagnosis and, thus, treatment may be delayed by an initial misleading clinical presentation including nonspecific extracardiac symptoms. Involvement of the peripheral nervous system as a first symptom of AM has been reported only once before and never in the form of multiple mononeuropathy.

CASE

We report the case of a 51-year-old woman who had suffered from pharmacoresistant neurological pain sequentially in several peripheral nerve territories for more than a year before the appearance of purpuric macules on the palms and soles and emergence of a biological inflammatory syndrome. Cardioembolic disease was suspected after radiological examination detected multiple asymptomatic renal and splenic infarctions and a small right frontal cortical ischemic stroke. Transoesophageal echocardiography revealed an atrial mass which was removed by surgery. AM was confirmed after histopathological analysis. The neurological pain resolved along with embolic and systemic signs of AM, and the patient has since been free of pain.

CONCLUSION

Multiple mononeuropathy is a possible symptom of AM and may precede onset of other embolic or systemic signs by several months.

Cardiac myxoma induced paraneoplastic syndromes: a review of the literature

BACKGROUND

Atrial myxomas are the most common benign tumors of the heart and may present with a wide variety of symptoms. Although 45% of patients present with neurological symptoms, a diverse range of systemic symptoms also occur.

METHODS

A systemic review of the literature related to the diagnosis, treatment, pathogenesis, and symptoms associated with atrial myxomas was performed.

RESULTS

Here we summarize the current state of understanding about myxoma pathogenesis and treatments are described. We review the common and rare local and systemic effects of myxomas. Additionally, we review the paraneoplastic and metastatic potential of myxomas.

CONCLUSIONS

A better understanding of the diverse disease presentations, paraneoplastic syndromes, and side effects of cytokine abnormalities stemming from myxomas will aid the physician in earlier detection and monitoring of disease recurrence.

Atrial myxoma and bone changes: a paraneoplastic syndrome?

Atrial myxomas are the most common benign tumors of the heart and are difficult to diagnose due to a wide variety of presenting symptoms. We present a patient with a five-year history of visual loss, vertigo, ataxia, tinnitus, and bone lesions that resolved after diagnosis and resection of an atrial myxoma. This case not only highlights an unusual presentation of atrial myxomas but also raises the question of whether atrial myxomas can produce paraneoplastic syndromes, including bone abnormalities. 

Supraventricular tachycardia associated with a clinically isolated demyelinating syndrome

Ion channels are essential to a wide range of physiological functions including neuronal signaling, muscle contraction, cardiac pacemaking, hormone secretion and cell proliferation. Linking ion-channel gene mutations to inherited disorders has been described. Ankyrins are intracellular proteins required for the biogenesis and maintenance of membrane domains in both excitable and non-excitable cells. Dysfunction in ankyrin-based pathways seems to link abnormalities in vertebrate physiology including ataxia, axonal degeneration and arrhythmias. Analyzing the evolution of the autonomic disturbances in the demyelinating syndromes, the early onset of arrhythmias has been described. We present a case of supraventricular tachycardia in a 45-year-old Italian woman with a clinically isolated demyelinating syndrome. Also this case focuses attention on the presence of arrhythmias in the demyelinating syndromes.