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Qiao ML, Ma L, Wang CB, Fang LB, Fan ZX, Niu TT, Wang ZY, Lu JF, Yuan BY, Liu GZ. Clinical features, risk factors and survival in cardiac myxoma-related ischemic stroke: A multicenter case-control study. J Neurol Sci 2023; 444:120517. [PMID: 36528975 DOI: 10.1016/j.jns.2022.120517] [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: 08/25/2022] [Revised: 11/11/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Cardiac myxoma (CM) is an important etiology of stroke in young adults, but studies on CM-related ischemic stroke (CM-IS) are limited and conflicting. Hence, we investigated clinical characterizations, risk factors of CM-IS, and short-term survival after surgical resection. METHODS We performed a retrospective analysis of data from all CM patients at three referral management centers and conducted follow-up examination. RESULTS Among 414 CM patients, 402 were recruited for further analysis, including 54 patients with CM-IS and 348 patients with CM without stroke (Non-stroke). In the acute phase, patients presented with NIHSS 3 (interquartile range: 0-10) and clinical presentation comprising neurological, cardiac and constitutional symptoms. Multivariate analysis showed that the factors associated with an increased risk of CM-IS were tumor width < 30 mm [OR = 2.652, 95% CI: 1.061-6.627, P = 0.037], tumors with high-mobility (OR = 2.700, 95% CI: 1.357-5.371, P = 0.005), thrombus on the tumor surface (OR = 1.856, 95% CI: 1.003-3.434, P = 0.049), and lower B-type natriuretic peptide (BNP) levels (OR = 0.995, 95% CI: 0.989-0.999, P = 0.047). The overall three-year survival rate was 95.7% (95% CI: 94.9-96.5) in CM-IS patients who underwent surgery. CONCLUSIONS CM-IS patients had mild or moderate neurologic deficits with various presentations at disease onset. Narrower tumor width, tumors with high-mobility, thrombus on the tumor surface, and lower BNP levels are potential predictors of CM-IS development. Surgical removal of CM is safe and efficacious in patients with CM-IS.
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Affiliation(s)
- Man-Li Qiao
- Department of General Practice Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Lin Ma
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Chao-Bin Wang
- Department of Neurology, Beijing Fangshan district Liangxiang Hospital, Beijing 102400, China
| | - Li-Bo Fang
- Department of Neurology, Beijing Fuxing Hospital, Capital Medical University, Beijing 100029, China
| | - Ze-Xin Fan
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Tian-Tong Niu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Ze-Yi Wang
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Jian-Feng Lu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Bo-Yi Yuan
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Guang-Zhi Liu
- Department of Neurology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China.
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2
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Shrestha GS, Rimal A, Shrestha SK, Shrestha PS, Acharyai SP. Recurrent Ischemic Stroke in a Patient with Atrial Myxoma: A Case Report. JNMA J Nepal Med Assoc 2022; 60:969-971. [PMID: 36705184 PMCID: PMC9795099 DOI: 10.31729/jnma.6693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Cardiac myxoma is an infrequent but curable cause of ischemic stroke. There are no guidelines addressing the timing of surgery to excise the tumour or for the use of thrombolysis or thrombectomy. We present a case with an ischemic stroke which was diagnosed to have atrial myxoma. She was planned for surgical excision of the tumour but suffered from a second ischemic stroke while awaiting surgery. This article aims to highlight vital aspects of this rare phenomenon and discuss the prospects of the timing of surgery and neurosurgical intervention. The importance of a proper cardiac evaluation in all cases of stroke is highlighted. Keywords cardiac tumour; myxoma; cardiac surgery; ischemic stroke.
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Affiliation(s)
- Gentle Sunder Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal,Correspondence: Dr Gentle Sunder Shrestha, Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal. , Phone: +977-9841248584
| | - Ankit Rimal
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | | | - Pramesh Sunder Shrestha
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Subhash Prasad Acharyai
- Department of Critical Care Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
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3
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Yoon BH, Byun J, Kim M, Lee S, Park JC, Ahn JS, Park W. The Influence of Neurological Disorders Before Cardiac Myxoma Surgery on the Rate of Postoperative Recurrences: Analysis of 317 Patients in a Single Center. World Neurosurg 2021; 158:e128-e137. [PMID: 34710580 DOI: 10.1016/j.wneu.2021.10.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Cardiac myxoma is a very rare disease for which resection is the gold standard treatment. Many neurological manifestations are associated with this disease, including embolic infarctions, arterial aneurysms, and brain metastatic myxomas, but few large-scale studies have addressed this. The aim of this study was to retrospectively analyze the incidence, type, and prognosis of these neurological disorders. METHODS We enrolled 317 patients who underwent a cardiac myxoma resection between 2004 and 2019 at our institution. A retrospective review of medical records and radiological imaging was performed for each patient, and clinical factors were compared and analyzed with regard to clinical outcomes and the incidence of adverse events. RESULTS Patients with a neurological disorder before surgery were found to be more likely to develop new postoperative neurological complications (P = 0.003). Patients with a neurological disorder arising at any time before or after surgery had poorer outcomes (P < 0.001). CONCLUSIONS The clinical management of cardiac myxoma must take account of neurological sequelae independently of the surgical intervention to remove the lesion. Patients with cardiac myxoma and any neurological disorder should undergo both neurosurgical follow-up and cardiac surgical follow-up, even if myxoma removal surgery has been performed. We recommend active neuroimaging during long-term follow-up as essential in these cases.
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Affiliation(s)
- Byul Hee Yoon
- Department of Neurosurgery, Uijeongbu Eulji Medical Center, Uijeongbu city, Gyeonggi-do, Korea
| | - Joonho Byun
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Moinay Kim
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seungjoo Lee
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Sung Ahn
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wonhyoung Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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4
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Bhatia V, Jain C, Ray S, Gupta O, Chatterjee D, Kumar A. Mechanical Thrombectomy in Embolic Cardiac Myxoma: Case Report and Literature Review. Neurol India 2021; 69:707-710. [PMID: 34169873 DOI: 10.4103/0028-3886.319216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Myxomas are the most common cardiac tumors and present clinically with cardiac manifestations, systemic constitutional symptoms, and embolic events. Posterior circulation involvement occurs in approximately 20 percent of cerebral ischemic events.The endovascular technique is an established life-saving therapy for eligible patients upto 24 hours from symptom onset. However, the role of endovascular management in embolic atrial myxoma remains unknown with no international consensus guidelines for the management of stroke in such patient population. Here, we present a case report of an embolic posterior circulation stroke in a young female treated with mechanical thrombectomy at 23 hours from symptom onset. To the best of our knowledge, this is the first thrombectomy case in posterior circulation with embolism from myxoma. Further workup confirmed an atrial myxoma which was resected. We also review the previous cases with mechanical thrombectomy done in such cases.
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Affiliation(s)
- Vikas Bhatia
- Department of Radio-diagnosis and Imaging, PGIMER, Chandigarh, India
| | - Chirag Jain
- Department of Radio-diagnosis and Imaging, PGIMER, Chandigarh, India
| | | | - Ojas Gupta
- Department of Histopathology, PGIMER, Chandigarh, India
| | | | - Ajay Kumar
- Department of Radio-diagnosis and Imaging, PGIMER, Chandigarh, India
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5
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Kulkarni G, R. Taallapalli A, Mondal M, Shaik R, Srijithesh PR. Treating triple thrombus-pulmonary, cardiac, and cerebral: A case management with calculated conscience. Ann Indian Acad Neurol 2021; 24:962-965. [PMID: 35359515 PMCID: PMC8965933 DOI: 10.4103/aian.aian_771_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/01/2020] [Accepted: 09/23/2020] [Indexed: 11/15/2022] Open
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6
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Esmaeili S, Shojaei SF, Bahadori M, Mojtahed M, Mehrpour M. Intravenous Thrombolysis for Acute Ischemic Stroke Due to Cardiac Myxoma. Basic Clin Neurosci 2020; 11:855-859. [PMID: 33850622 PMCID: PMC8019853 DOI: 10.32598/bcn.11.6.1844.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 06/20/2019] [Accepted: 02/10/2020] [Indexed: 11/21/2022] Open
Abstract
Background: Myxoma may cause systemic embolization and frequently presents as ischemic stroke. Case Presentation: There have been debates about whether it is safe to use recombinant tissue plasminogen activator (rt-PA) in patients with cardiac myxoma who referred with ischemic stroke to the hospital’s emergency. Results: The patient was a young case of atrial myxoma with initial presentation of acute cerebral infarction symptoms who was treated with intravenous rt-PA with no complications. Conclusion: The case provides an evidence of the efficacy and safety of intravenous rt-PA in cases of cardiac myxoma. However, we cannot always expect thrombolytic therapy to be effective, especially in tumor emboli.
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Affiliation(s)
- Sara Esmaeili
- Department of Neurology, Cellular and Molecular Research Center, Firoozgar Hospital, Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Fahimeh Shojaei
- Firoozgar Clinical Research and Development Center (FCRDC), Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Bahadori
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mojtahed
- Department of Neurology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Mehrpour
- Department of Neurology, School of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
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7
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Dong M, Ge Y, Li J, Fu K, Zhang L, Teng W, Tian L. Intravenous thrombolysis for pure pontine infarcts caused by cardiac myxoma: a case report and literature review. Int J Neurosci 2019; 130:635-641. [PMID: 31818173 DOI: 10.1080/00207454.2019.1702537] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: Cardiac myxoma (CM) is a rare but important cause of ischemic stroke, and typically involves the middle cerebral artery and rarely affects the brainstem only. The safety and efficacy of intravenous thrombolysis (IVT) for CM-related acute cerebral embolism are not clear.Methods: We report a case of a 55-year-old woman who suffered a CM-related acute cerebral embolism presented with pure pontine infarcts and achieved a favorable prognosis by IVT with urokinase. We summarized the clinical data of this entity and performed a literature review of 21 previous reports of patients with CM-related acute cerebral embolism who were treated with IVT.Results: In combination with previous reports, we found that the majority of patients (81.8%) obtained improvements in symptoms after IVT, including 63.6% in remarkable clinical improvement. The total rate of IVT-induced intracerebral hemorrhage was 22.7% and all occurred within 36 h, including hemorrhagic infarction type 1 (4.5%) and parenchymal hematoma type 2 (18.2%). Most of the cases had relatively good outcomes and no case died due to IVT.Conclusion: Taken together, our findings support the use of IVT as an effective and safe tool for the ultra-early treatment of CM-related acute phase ischemic stroke.
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Affiliation(s)
- Mingming Dong
- Department of Neurology, The Fourth People's Hospital of Shenyang, Shenyang, China
| | - Yusong Ge
- Department of Neurology, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jinwei Li
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Kailei Fu
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Liyang Zhang
- Department of Neurology, The Fourth People's Hospital of Shenyang, Shenyang, China
| | - Weiyu Teng
- Department of Neurology, The First Hospital of China Medical University, Shenyang, China
| | - Li Tian
- Department of Geriatrics, Shengjing Hospital of China Medical University, Shenyang, China
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8
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Jawaid A, Naqvi SY, Wiener R. Atrial myxoma presenting as acute ischaemic stroke and chronic right lower leg claudication. BMJ Case Rep 2018; 11:11/1/e227427. [PMID: 30567250 DOI: 10.1136/bcr-2018-227427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A 48-year-old man presented with acute onset of left facial numbness, ataxic gait and double vision. He also complained of chronic right lower leg pain with acute onset a year prior to presentation. His vital signs were within normal limits. Physical exam was notable for right-sided intranuclear opthalmoplegia, decreased sensation to light touch on the left side of his body, left-sided dysmetria and ataxic gait. Neuroimaging showed evidence of acute stroke in the cerebellum and brainstem, for which he was treated with thrombolytics. An echocardiogram revealed a 5×3 cm left atrial myxoma, which was surgically resected. Subsequent imaging of his lower extremity revealed a chronic common iliac artery occlusion for which he underwent angioplasty. His claudication symptoms resolved, and he was without any neurological deficits at a 2-year follow-up visit.
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Affiliation(s)
- Anas Jawaid
- Internal Medicine Department, Strong Memorial Hospital, Rochester, New York, USA
| | - Syed Yaseen Naqvi
- Cardiology Division, Strong Memorial Hospital, Rochester, New York, USA
| | - Roy Wiener
- Cardiology Division, Strong Memorial Hospital, Rochester, New York, USA
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9
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Stefanou MI, Rath D, Stadler V, Richter H, Hennersdorf F, Lausberg HF, Lescan M, Greulich S, Poli S, Gawaz MP, Ziemann U, Mengel AM. Cardiac Myxoma and Cerebrovascular Events: A Retrospective Cohort Study. Front Neurol 2018; 9:823. [PMID: 30337904 PMCID: PMC6178925 DOI: 10.3389/fneur.2018.00823] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/11/2018] [Indexed: 12/12/2022] Open
Abstract
Background: Cardiac myxoma (CM) is the most frequent, cardiac benign tumor and is associated with enhanced risk for cerebrovascular events (CVE). Although surgical CM excision is the only curative treatment to prevent CVE recurrence, in recent reports conservative treatment with antiplatelet or anticoagulant agents in high-risk patients with CM-related CVE has been discussed. Methods: Case records at the University Hospital of Tübingen between 2005 and 2017 were screened to identify patients with CM-related CVE. Clinical features, brain and cardiac imaging findings, histological reports, applied treatments and long-term neurological outcomes were assessed. Results: 52 patients with CM were identified and among them, 13 patients with transient ischemic attack, ischemic stroke or retinal ischemia were included to the (to our knowledge) largest reported retrospective study of CM-related CVE. In all identified patients, CVE was the first manifestation of CM; 61% suffered ischemic stroke, 23% transient ischemic attack and 15% retinal ischemia. In 46% of the patients, CVE occurred under antiplatelet or anticoagulation treatment, while 23% of the patients developed recurrent CVE under bridging-antithrombotic-therapy prior to CM surgical excision. Prolonged time interval between CVE and CM-surgery was significantly associated with CVE recurrence (p = 0.021). One patient underwent i.v. thrombolysis, followed by thrombectomy, with good post-interventional outcome and no signs of hemorrhagic transformation. Discussion: Our results suggest that antiplatelet or anticoagulation treatment is no alternative to cardiac surgery in patients presenting with CM-related CVE. We found significantly prolonged time-intervals between CVE and CM surgery in patients with recurrent CVE. Therefore, we suggest that the waiting- or bridging-interval with antithrombotic therapy until curative CM excision should be kept as short as possible. Based on our data and review of the literature, we suggest that in patients with CM-related CVE, i.v. thrombolysis and/or endovascular interventions may present safe and efficacious acute treatments.
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Affiliation(s)
- Maria-Ioanna Stefanou
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Dominik Rath
- Department of Cardiology, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Vera Stadler
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Hardy Richter
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Florian Hennersdorf
- Department of Diagnostic and Interventional Neuroradiology, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Henning F Lausberg
- Department of Thoracic and Cardiovascular Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Mario Lescan
- Department of Thoracic and Cardiovascular Surgery, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Simon Greulich
- Department of Cardiology, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Sven Poli
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Meinrad P Gawaz
- Department of Cardiology, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Ulf Ziemann
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
| | - Annerose M Mengel
- Department of Neurology and Stroke, and Hertie-Institute for Clinical Brain Research, Eberhard-Karls University of Tübingen, Tübingen, Germany
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10
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Díaz Díaz A, Muñoz García A, Pinar Sedeño G, García Rodríguez J. Intravenous fibrinolysis for acute ischaemic stroke associated with left atrial myxoma: A case report. NEUROLOGÍA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.nrleng.2016.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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11
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Díaz Díaz A, García AM, Sedeño GP, García Rodríguez J. Tratamiento fibrinolítico intravenoso en el manejo del ictus isquémico agudo asociado a mixoma auricular izquierdo: a propósito de un caso. Neurologia 2018; 33:267-268. [DOI: 10.1016/j.nrl.2016.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 02/10/2016] [Accepted: 02/12/2016] [Indexed: 11/16/2022] Open
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12
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Novak M, Fila P, Hlinomaz O, Zampachova V. The First Manifestation of a Left Atrial Myxoma as a Consequence of Multiple Left Coronary Artery Embolisms. J Crit Care Med (Targu Mures) 2017; 3:111-117. [PMID: 29967881 PMCID: PMC5769897 DOI: 10.1515/jccm-2017-0018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 07/04/2017] [Indexed: 11/15/2022] Open
Abstract
A case of multiple embolisms in the left coronary artery as a rare first manifestation of left atrial myxoma is reported. A patient with embolic myocardial infarction and congestive heart failure was treated by percutaneous aspirations and balloon dilatations. Transesophageal echocardiography disclosed a villous myxoma with high embolic potential. Surgical resection of the tumour, suturing of a patent foramen ovale suture and an annuloplasty of the dilated tricuspid annulus was performed the third day after the admission. Recovery of the documented left ventricular systolic function can be explained by resorption of myxomatous material. The patient was discharged ten days after the surgery.
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Affiliation(s)
- Martin Novak
- Department of Cardiology, St. Anne’s University Hospital Brno, Pekarska 53, 65691Brno, Czech Republic
- International Clinical Research Center, Pekarska 53, 65691Brno, Czech Republic
| | - Petr Fila
- Centre of Cardiovascular and Transplantation Surgery, Pekarska 53, 65691Brno, Czech Republic
| | - Ota Hlinomaz
- Department of Cardiology, St. Anne’s University Hospital Brno, Pekarska 53, 65691Brno, Czech Republic
- International Clinical Research Center, Pekarska 53, 65691Brno, Czech Republic
| | - Vita Zampachova
- Department of Pathology, St. Anne’s University Hospital Brno, Pekarska 53, 65691Brno, Czech Republic
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13
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Intravenous thrombolysis in a patient with left atrial myxoma. Neurol Sci 2017; 38:1345-1346. [DOI: 10.1007/s10072-017-2937-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 03/24/2017] [Indexed: 11/26/2022]
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14
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Quan H, Liang P, Tan Y. The Value of Multi-slice CT Imaging in Cardiac Myxomas in Comparison with Follow-Up Screening in Thoracoscopic Surgery. Cell Biochem Biophys 2016; 73:565-569. [PMID: 27352354 DOI: 10.1007/s12013-015-0689-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this study, we evaluated the ability of multi-slice CT (MSCT) imaging for the diagnosis of cardiac myxomas (CMs) in comparison with follow-up screening in thoracoscopic surgery. 40 consecutive patients who had CMs confirmed by thoracoscopic surgery underwent MSCT scanning. The radiological findings were analyzed to reveal the tumor location, appearance, size, pedicle diameter and originating, and compared with surgical outcomes in the follow-up studies. We found that the tumor location and appearance were all definitely diagnosed in the radiological findings and were consistent with the surgical outcomes with the coincidence rate of 100 %. All the tumors showed heterogeneous enhancement, with a pedicle originating from the atrial septum. Compared with the results of surgical outcomes, the accuracy of MSCT for measuring tumor size and pedicle diameter has no statistical difference. The results indicate that MSCT imaging provides a great incremental value for the diagnosis of CMs in comparison with follow-up screening in thoracoscopic surgery.
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Affiliation(s)
- Hongjun Quan
- Department of Radiology, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China.
| | - Pan Liang
- Department of CT, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanzhao Tan
- The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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McGowan AR, Thibodeau C, McGowan A. Intracranial and visceral arterial embolization of a cardiac myxoma that was treated with endovascular stent-retriever therapy. Interv Neuroradiol 2016; 22:535-9. [PMID: 27306523 DOI: 10.1177/1591019916653939] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 05/15/2016] [Indexed: 11/17/2022] Open
Abstract
We report a case of a ruptured left atrial myxoma with multiple synchronous sites of embolization, including the intracranial cerebral (left middle cerebral artery (MCA) and basilar), visceral (renal, superior mesenteric artery (SMA)) and peripheral circulatory beds (aorta and lower extremities). This synchronous embolization resulted in a catastrophic neurologic and systemic event. An intracranial stent retriever was used to restore cerebral circulation in the symptomatic left MCA distribution, which resulted in resolution of the acute neurologic deficits. Endovascular and open surgical interventions were later performed to address the residual cardiac mass and other embolic sites. The patient survived the event with the loss of her right leg below the knee and a transient dialysis requirement. The purpose of this case report is to document the successful utilization of a stent-retriever device in removing an embolized myxoma from the cerebral circulation, to review the unique pathology of this source of embolic stroke and to reiterate the importance of considering embolic and non-thrombotic etiologies of acute ischemic stroke, especially in atypical patient populations and patient presentations.
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16
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Ikeda T, Oomura M, Sato C, Anan C, Yamada K, Kamimoto K. [Cerebral infarction due to cardiac myxoma developed with the loss of consciousness immediately after defecation-a case report]. Rinsho Shinkeigaku 2016; 56:328-333. [PMID: 27151226 DOI: 10.5692/clinicalneurol.cn-000856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 74-year-old man lost consciousness immediately after defecation. The loss of consciousness lasted for several minutes, and he experienced difficulty in walking when he regained consciousness. He was transferred to our hospital via an ambulance. Upon neurological examination, nystagmus and ataxia in the left arm and leg were noted. An MRI of the brain revealed multiple acute infarcts mainly in the bilateral cerebellum. Intravenous thrombolytic therapy with alteplase was initiated 3 h and 20 min after the onset of symptoms, and an improvement in neurological symptoms was observed. Echocardiography displayed a mobile mass in the left atrium, suggesting myxoma. After 14 days from the onset of symptoms, the tumor was surgically resected, and a pathological diagnosis of myxoma was established. Because of the unique event surrounding the onset in this case, we considered that there was a potential detachment of myxoma and/or thrombi fragments triggered by an increase in intrathoracic pressure induced by the action of defecation. This present case suggests that clinicians should consider cardiac myxoma in patients with cerebral infarction if the stroke is preceded by a Valsalva maneuver-like action and accompanied by the loss of consciousness.
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Ryu B, Ishikawa T, Sato S, Yokote A, Nakamoto H, Nie M, Okada Y. Mechanical Endovascular Recanalization in a Patient with Middle Cerebral Artery Occlusion by Tumorous Emboli Originating from Cardiac Myxoma. NMC Case Rep J 2015; 2:53-56. [PMID: 28663964 PMCID: PMC5364909 DOI: 10.2176/nmccrj.2014-0359] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/17/2014] [Indexed: 11/24/2022] Open
Abstract
Cardiac tumor is a rare cause of cerebral embolic infarction which has no established therapeutic strategies. Although some cases were successfully treated by recombinant tissue-plasminogen activator (rt-PA), this article indicates the effectiveness of emergency mechanical thrombectomy for tumorous type of emboli which do not respond to rt-PA. A 34-year-old man presented with ischemic stroke and right middle cerebral artery (MCA) occlusion by cardiac tumor originating emboli. Intravenous rt-PA therapy was ineffective, but mechanical endovascular thrombectomy using Merci Retriever was successful. His neurological deficit began to improve and good outcome was obtained at discharge. The embolus was histologically identical to a cardiac myxoma, confirmed and treated successfully by surgery later. We report the first successfully treated tumorous embolic stroke case with cardiac tumor by using Merci Retriever. Emergency mechanical thrombectomy would be an option for elastic hard myxoma emboli.
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Affiliation(s)
- Bikei Ryu
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo.,Department of Neurosurgery, Ebina General Hospital, Ebina, Kanagawa
| | - Tatsuya Ishikawa
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Shinsuke Sato
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
| | - Akiyoshi Yokote
- Department of Neurosurgery, Ebina General Hospital, Ebina, Kanagawa
| | | | - Masaki Nie
- Department of Cardiovascular Surgery, Ebina General Hospital, Ebina, Kanagawa
| | - Yoshikazu Okada
- Department of Neurosurgery, Tokyo Women's Medical University, Tokyo
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18
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Ryu B, Ishikawa T, Sato S, Yokote A, Nakamoto H, Nie M, Okada Y. Mechanical Endovascular Recanalization in a Patient with Middle Cerebral Artery Occlusion by Tumorous Emboli Originating from Cardiac Myxoma. NMC Case Rep J 2015. [DOI: 10.2176/nmccrj.cr.2014-0359] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Bikei Ryu
- Department of Neurosurgery, Ebina General Hospital
- Department of Neurosurgery, Tokyo Women’s Medical University
| | | | - Shinsuke Sato
- Department of Neurosurgery, Tokyo Women’s Medical University
| | | | | | - Masaki Nie
- Department of Cardiovascular Surgery, Ebina General Hospital
| | - Yoshikazu Okada
- Department of Neurosurgery, Tokyo Women’s Medical University
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19
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Kulkarni GB, Yadav R, Mustare V, Modi S. Intravenous thrombolysis in a patient with left atrial myxoma with acute ischemic stroke. Ann Indian Acad Neurol 2014; 17:455-8. [PMID: 25506173 PMCID: PMC4251025 DOI: 10.4103/0972-2327.144038] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/08/2014] [Accepted: 05/14/2014] [Indexed: 11/26/2022] Open
Abstract
Intravenous thrombolysis (IVT) is an accepted therapy in patients with acute ischemic stroke presenting within 3-4.5 hours of symptom onset. Selection of the patient for thrombolysis depends on the careful assessment for the risk of post thrombolysis symptomatic haemorrhage (6.2-8.9%) which may be fatal. Atrial myxomas which are the commonest tumors of the heart are associated with stroke due to tumor/clot embolism. There are very few case reports of IVT and its outcome in patients with atrial myxoma with stroke. Some have reported successful thrombolysis, while others have reported intracerebral bleeding. In this report we describe our experience of IVT in atrial myxoma patient with ischemic stroke and review the relevant literature.
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Affiliation(s)
- Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Veerendrakumar Mustare
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sailesh Modi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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20
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Chutinet A, Roongpiboonsopit D, Suwanwela NC. Intracerebral hemorrhage after intravenous thrombolysis in patients with cerebral microbleeds and cardiac myxoma. Front Neurol 2014; 5:252. [PMID: 25520700 PMCID: PMC4248841 DOI: 10.3389/fneur.2014.00252] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 11/15/2014] [Indexed: 12/19/2022] Open
Abstract
Background and purpose: Cardiac myxoma is a rare etiology of stroke. Both cerebral microbleeds and cardiac myxoma may increase the risk of intracerebral hemorrhage after intravenous (IV) thrombolysis. However, data are still limited. We report a case of multiple cerebral microbleeds treated with IV thrombolysis with later findings of cardiac myxoma. Summary of case: A 58-year-old-man presented with right-sided hemiplegia and global aphasia. The presumptive diagnosis of acute left middle cerebral artery (MCA) infarction was made. Previous magnetic resonance imaging showed multiple cerebral microbleeds. The patient received IV thrombolysis. Bilateral cerebellar hemorrhage occurred after thrombolysis, and a median suboccipital craniectomy and hematoma removal was performed. Transthoracic echocardiogram found a left atrial myxoma. The tumor was then surgically removed. Six months later, neurological deficit improved. Conclusion: Cerebral microbleeds may be associated with atrial myxoma. IV thrombolysis could benefit acute ischemic stroke patients with both baseline cerebral microbleeds and atrial myxoma.
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Affiliation(s)
- Aurauma Chutinet
- Faculty of Medicine, Department of Medicine, Division of Neurology, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok , Thailand
| | - Duangnapa Roongpiboonsopit
- Faculty of Medicine, Department of Medicine, Division of Neurology, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok , Thailand ; Faculty of Medicine, Department of Medicine, Naresuan University , Phitsanulok , Thailand
| | - Nijasri C Suwanwela
- Faculty of Medicine, Department of Medicine, Division of Neurology, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society , Bangkok , Thailand
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21
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Mackie BD, Shirazi F, Swadley MJ, Williams BR, Kumar G, Rab ST. Catastrophic systemic embolization from a left atrial myxoma. Tex Heart Inst J 2014; 41:64-6. [PMID: 24512404 DOI: 10.14503/thij-12-2964] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We report the fatal course of a left atrial myxoma: its systemic embolization to the coronary, cerebral, renal, and peripheral vascular beds in a 39-year-old woman resulted in rapid clinical deterioration, multiorgan failure, and death. Among reported cases of left atrial myxoma, this degree of embolic burden is exceedingly rare. In addition to reporting the patient's case, we discuss the presentation and diagnosis of possible intracardiac sources of systemic emboli.
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Affiliation(s)
- Benjamin D Mackie
- Division of Cardiology (Drs. Kumar, Mackie, Rab, Shirazi, and Williams), Emory University School of Medicine; and Department of Pathology and Laboratory Medicine (Dr. Swadley), Emory University Hospital; Atlanta, Georgia 30322
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22
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Habbab L, Alfaraidi H, Lamy A. Surviving catastrophic disintegration of a large left atrial myxoma: the importance of multi-disciplinary team. J Surg Case Rep 2014; 2014:rju093. [PMID: 25217477 PMCID: PMC4161989 DOI: 10.1093/jscr/rju093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Atrial myxomas are the most common primary cardiac tumors, representing ∼50% of all benign cardiac tumors. Patients with a left atrial myxoma (LAM) generally present with symptoms of mechanical obstruction of blood flow, systemic emboli or constitutional symptoms. Embolic complications may occur any time with progression of the tumor; therefore, myxoma is usually considered an indication for urgent surgery. This report describes a patient with mobile large LAM who survived multiple emboli to the brain, spleen, kidneys, abdominal aorta and lower limbs during hospitalization for surgery, illustrating the critical nature of this finding and its possible catastrophic complications and demonstrating the importance of multi-disciplinary team in the decision-making process and the management of such complications and supporting the hypothesis that intravenous thrombolysis may be safely used in the treatment of embolic stroke due to cardiac myxoma.
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Affiliation(s)
- Louay Habbab
- Division of Cardiac Surgery, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada
| | - Haifa Alfaraidi
- Division of Cardiac Surgery, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada
| | - Andre Lamy
- Division of Cardiac Surgery, Hamilton General Hospital, McMaster University, Hamilton, ON, Canada
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23
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Baek SH, Park S, Lee NJ, Kang Y, Cho KH. Effective mechanical thrombectomy in a patient with hyperacute ischemic stroke associated with cardiac myxoma. J Stroke Cerebrovasc Dis 2014; 23:e417-9. [PMID: 25174564 DOI: 10.1016/j.jstrokecerebrovasdis.2014.05.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 04/25/2014] [Accepted: 05/03/2014] [Indexed: 10/24/2022] Open
Abstract
Ischemic stroke is the most common neurologic manifestation of cardiac myxoma. However, there has been no current guideline on the treatment of hyperacute ischemic stroke due to cardiac myxoma. We describe a patient with hyperacute stroke caused by cardiac myxoma who had a good outcome with rapid recanalization through mechanical thrombectomy. A 46-year-old man was admitted with acute symptoms of right side hemiplegia and global aphasia. Brain computed tomography (CT) angiography showed a T occlusion of the left internal carotid artery. Intravenous recombinant tissue plasminogen activator was administered. However, his clinical symptoms did not improve. Thus, we performed endovascular treatment and had a successful outcome. A pathologic examination of the retrieved clot revealed a tumor emboli from a cardiac myxoma. Transthoracic echocardiogram revealed a left atrial myxoma in which a large mass was attached to the posterior wall of the aorta. The patient's neurologic deficits recovered with the exception of left eye blindness. Reperfusion therapy with mechanical thrombectomy might be safe and effective for the rapid revascularization of large vessel occlusions in hyperacute ischemic stroke, from which the tumor thrombi can be retrieved.
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Affiliation(s)
- Seol-Hee Baek
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Soonchan Park
- Department of Radiology, Korea University College of Medicine, Seoul, Republic of Korea; Department of Radiology, School of Medicine, Kyung Hee University, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Nam Joon Lee
- Department of Radiology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Youngjin Kang
- Department of Pathology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyung-Hee Cho
- Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea.
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24
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van den Wijngaard I, Wermer M, van Walderveen M, Wiendels N, Peeters-Scholte C, Lycklama À Nijeholt G. Intra-arterial treatment in a child with embolic stroke due to atrial myxoma. Interv Neuroradiol 2014; 20:345-51. [PMID: 24976098 DOI: 10.15274/inr-2014-10026] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 01/01/2014] [Indexed: 11/12/2022] Open
Abstract
Arterial ischaemic stroke is an important cause of morbidity in children. Timely diagnosis is necessary for acute stroke treatment but can be challenging in clinical practice. Due to a paucity of data there are no specific recommendations regarding the use of mechanical thrombectomy devices in current paediatric stroke guidelines. A 14-year-old boy presented with a severe acute left hemisphere stroke due to a proximal middle cerebral artery occlusion caused by emboli from an atrial myxoma. No clinical improvement was seen after administration of intravenous thrombolysis. Subsequent mechanical thrombectomy with a second-generation stent-based thrombectomy device resulted in successful recanalization and clinical improvement. To our knowledge, this is the first report of mechanical thrombectomy in a child with acute embolic stroke caused by atrial myxoma.
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Affiliation(s)
- Ido van den Wijngaard
- Department of Radiology, Medical Center Haaglanden; The Hague, The Netherlands - Department of Neurology, Leiden University Medical Center; Leiden, The Netherlands -
| | - Marieke Wermer
- Department of Neurology, Leiden University Medical Center; Leiden, The Netherlands
| | | | - Natalie Wiendels
- Department of Neurology, Leiden University Medical Center; Leiden, The Netherlands
| | - Cacha Peeters-Scholte
- Department of Paediatric Neurology, Leiden University Medical Center; Leiden, The Netherlands
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25
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Kamiya Y, Ichikawa H, Mizuma K, Itaya K, Shimizu Y, Kawamura M. A case of acute ischemic stroke due to cardiac myxoma treated by intravenous thrombolysis and endovascular therapy. Rinsho Shinkeigaku 2014; 54:502-6. [PMID: 24990835 DOI: 10.5692/clinicalneurol.54.502] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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26
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Kohno N, Kawakami Y, Hamada C, Toyoda G, Bokura H, Yamaguchi S. Cerebral embolism associated with left atrial myxoma that was treated with thrombolytic therapy. Case Rep Neurol 2012; 4:38-42. [PMID: 22545036 PMCID: PMC3335447 DOI: 10.1159/000336179] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We present a case of cerebral embolism associated with a left atrial myxoma that was treated with intravenous thrombolytic therapy. A 79-year-old right-handed man with no history of neurological or psychiatric illnesses was referred to our hospital because of confusion. He had been self-supported in the activity of daily living and could enjoy gardening until just before his admission. He had aphasia, left conjugate deviation, right hemiparesis, and right pathological reflexes. His NIHSS score was 24. Cranial DWI showed hyperintense lesions in the left middle cerebral artery territory, and MRA revealed left middle cerebral artery occlusion. We started treatment with the recombinant tissue plasminogen activator alteplase intravenously 3 h after the onset. However, the therapy was ineffective, and the NIHSS score was 25 on the second day. A transthoracic echocardiogram and heart MRI showed a left atrial myxoma. However, surgery was contraindicated because of the patient's poor general condition. Although intravenous recombinant tissue plasminogen activator is a reasonable treatment for stroke patients, even with a cardiac myxoma, we cannot always expect good effects, especially if the emboli are parts of the tumor itself. In this case, we could not perform an endovascular mechanical embolectomy; however, we speculate that mechanical embolus retrieval in cerebral ischemia might be effective in such cases.
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Affiliation(s)
- Naoto Kohno
- Department of Neurology, Shimane Prefectural Central Hospital, Izumo, Japan
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