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Wang A, Wang Z, Hu K, Liu J, Cao Q, Zhang Z, Si Z. Delayed multiple intracranial aneurysms caused by left atrial myxoma: a case report and literature review. Transl Pediatr 2022; 11:149-156. [PMID: 35242661 PMCID: PMC8825931 DOI: 10.21037/tp-21-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
Intracranial aneurysm may appear even after the removal of the cardiac myxoma. However, the pathogenesis and treatment of such aneurysm lesions are not clear. The study aimed to explore the clinical and imaging manifestation, hypothetical pathogenesis, and therapy in one case of left atrial myxoma causing multiple intracranial aneurysms. A 14-year-old male displayed a 3-hour history of episodic loss of consciousness and right hemiplegia after a leapfrog-like movement. The myxoma was diagnosed by a combination of clinical examination, leading to the diagnosis of mitral dynamic obstruction with a Grade III mitral diastolic murmur and tumor plop; magnetic resonance imaging, revealing multiple ischemic sites in both semi-oval centers; and transthoracic echocardiography, demonstrating a mitral valve obstruction. The myxoma was removed surgically; however, computed tomography angiography showed multiple intracranial aneurysms in both middle cerebral arteries 18 months after resection of the atrial myxoma. After conservative treatment, the patient had no neurological dysfunction symptoms for 5 years after myxoma resection. His condition is relatively stable. In conclusion, resection of the atrial myxoma may eliminate the early neurological symptoms, but it cannot ensure the nonoccurrence of delayed intracranial aneurysms. The neoplastic process theory was favored for explaining the aneurysm development in this case. According to the specific conditions of the patient, a combination of open surgery, chemotherapy, radiotherapy, and coil embolization is recommended.
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Affiliation(s)
- Aihua Wang
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Zhaoxia Wang
- Department of Neurology, Juxian People's Hospital, Rizhao, China
| | - Ke Hu
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Emergency Medicine, Jinan, China
| | - Jinzhi Liu
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
| | - Qiwei Cao
- Department of Pathology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Medicine and Health Key Laboratory of Clinical Pathology, Shandong Lung Cancer Institute, Shandong Institute of Nephrology, Jinan, China
| | - Zixian Zhang
- Department of Neurology, Zaozhuang Municipal Hospital, Zaozhuang, China
| | - Zhihua Si
- Department of Neurology, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Neuroimmunology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, Jinan, China
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Elsebaie N, Abdelzaher A, Gamaleldin O. Atypical intracranial aneurysms: spectrum of imaging findings in computed tomography and magnetic resonance imaging. Clin Imaging 2021; 83:1-10. [PMID: 34915276 DOI: 10.1016/j.clinimag.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/25/2022]
Abstract
We aim to describe demographics, clinical presentation, and spectrum of CT and MRI features suggestive of atypical intracranial aneurysms. The imaging protocols used for the diagnosis of intracranial aneurysms were thoroughly reviewed, including different CT and MRI protocols. We classified atypical aneurysms according to their location, size, clinical presentation, and specific imaging features. Dissecting aneurysms are one of the causes of stroke in young adults that may show intimal flap and double lumen. Traumatic intracranial aneurysms are a rare but serious complication of head injuries. Mycotic aneurysms are small and multiple at distal branch points with a high risk of rupture. Aneurysms with vasculitis are fusiform with a wide neck at a non-branch point that may be associated with vessel wall enhancement. Atherosclerotic aneurysms are usually large fusiform that affect large arteries. Oncotic aneurysms are relatively rare. They were reported to occur in patients with left atrial myxoma. Our study represented a wide spectrum of atypical intracranial aneurysms with their detailed diagnostic imaging findings on MRI and CT including newly introduced MRI sequences, which greatly influenced early diagnosis and timely management.
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Affiliation(s)
- Nermeen Elsebaie
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion street, Alexandria 21131, Egypt.
| | - Ahmed Abdelzaher
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Omneya Gamaleldin
- Diagnostic and Interventional Radiology Department, Alexandria Faculty of Medicine, Shamplion street, Alexandria 21131, Egypt
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Jain S, Nga VDW, Venketasubramanian N. Late Diagnosis of Multiple Cerebral Aneurysms A Decade after Resection of Cardiac Myxoma. Case Rep Neurol 2021; 12:189-195. [PMID: 33505294 DOI: 10.1159/000505390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/11/2019] [Indexed: 11/19/2022] Open
Abstract
Cerebral embolism from a cardiac myxoma is a rare cause of ischaemic stroke. These emboli may later lead to the development of cerebral aneurysms. We report a case of delayed presentation of neurological manifestations in form of multiple intracranial aneurysms many years after treatment of a cardiac myxoma. Our patient, a 55-year-old right-handed female with a background history of hypertension, first presented at the age of 45 years with a sudden onset of right hemiplegia. A CT brain scan detected multiple infarcts in the territory of the left middle cerebral artery. Echocardiography revealed a cardiac myxoma for which she underwent immediate total surgical resection. Nearly 10 years after this diagnosis, she presented again with right-sided weakness and left ptosis. CT scan of the brain revealed bilateral acute superior cerebellar infarcts with interval evolution of previously known left cortical infarcts. MRI/MR angiogram showed multiple aneurysms arising from the bilateral middle, left anterior and left posterior cerebral arteries. She was managed conservatively. The management of multiple aneurysms with cardiac myxomas is highly debatable and dependent on the patient's presentation. This case highlights the importance to follow up on potential late extra-cardiac manifestations of the myxomas despite adequate resection.
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Affiliation(s)
- Swati Jain
- Division of Neurosurgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Vincent Diong Wen Nga
- Division of Neurosurgery, University Surgical Cluster, National University Health System, Singapore, Singapore
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Tona C, Nosadini M, Pelizza MF, Pin JN, Baggio L, Boniver C, Gabrieli JD, Causin F, Toldo I, Sartori S. Cardiac Myxoma as a Rare Cause of Pediatric Arterial Ischemic Stroke: Case Report and Literature Review. Neuropediatrics 2020; 51:389-396. [PMID: 32369836 DOI: 10.1055/s-0040-1710338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Cardiac disorders are the second leading cause of pediatric arterial ischemic stroke (AIS). Limited literature is available on pediatric AIS caused by cardiac myxoma, a rare tumor in childhood. METHODS We describe a new case of pediatric AIS due to a previously unknown atrial myxoma and we conduct a literature review on children with AIS due to cardiac myxoma. RESULTS We identified 41 published pediatric cases of AIS and cardiac myxoma, including ours (56% males, median age at AIS was 11 years [range: 3-18]). AIS presentation was most frequently with hemiparesis/hemiplegia (89%). Multiple brain ischemic lesions were detected in 69% of patients, and arteriopathy in 91%. Seven patients underwent mechanical thrombectomy. At AIS presentation, 73% of children had one or more of the following clinical symptoms/signs suggesting a possible underlying cardiac myxoma: Carney's complex, cardiac auscultation abnormalities, extraneurological symptoms/signs, such as skin signs (12, 38, and 65%, respectively). Cardiac myxoma was diagnosed within 72 hours in 68% of cases. Death occurred in 11%, and 40% had persistent neurological deficits. CONCLUSION Neurological presentation of AIS due to cardiac myxoma is similar to that of AIS with other etiologies, although clues suggesting a possible underlying cardiac myxoma can be detected in most cases. A timely diagnosis of cardiac myxoma in patients with AIS may favor prompt identification of candidates for endovascular therapy. Therefore, we suggest that in otherwise-healthy children presenting with AIS, transthoracic echocardiography should be performed early after stroke presentation.
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Affiliation(s)
- Clarissa Tona
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Maria F Pelizza
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Jacopo N Pin
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Laura Baggio
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Clementina Boniver
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | | | - Francesco Causin
- Neuroradiology Unit, University Hospital of Padua, Padova, Italy
| | - Irene Toldo
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padova, Italy
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Panos LD, Brunel C, Berezowska S, Engisch R, Kollar A, Bassetti C, Sturzenegger M, Krestel H. Early and delayed neurological manifestations of cardiac myxomas. Clin Neurol Neurosurg 2020; 190:105673. [PMID: 31945622 DOI: 10.1016/j.clineuro.2020.105673] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 12/27/2019] [Accepted: 01/05/2020] [Indexed: 10/25/2022]
Abstract
Cardiac myxoma can embolize and cause early and delayed sequelae including stroke, growth into intracranial fusiform aneurysms and cerebral tumors with risk of hemorrhage and mass effect. Here, we report the rare coincidence of all these manifestations in a 63-year-old man who presented with cognitive and behavioral changes, and seizures 9 months after an embolic stroke from the heart tumor. C-reactive protein (CRP) was elevated at the time of stroke and cardiac myxoma diagnosis but was normal at late neurologic manifestation with isolated myxoma-related intracranial tumors and aneurysms. Low-dose whole-brain radiotherapy can be helpful to diminish cerebral myxoma tumors and fusiform aneurysms despite reported increased risk of aneurysm rupture.
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Affiliation(s)
- Leonidas D Panos
- Departments of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland.
| | - Christophe Brunel
- Institute of Pathology, University Hospital Center and University of Lausanne, Lausanne, Switzerland
| | | | - Renate Engisch
- Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Attila Kollar
- Departments of Oncology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Claudio Bassetti
- Departments of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Mathias Sturzenegger
- Departments of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Heinz Krestel
- Departments of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland.
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