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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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2
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Sato T, Saji N, Kobayashi K, Shibazaki K, Kimura K. [A case of cerebral embolism due to cardiac myxoma presenting with multiple cerebral microaneurysms detected on first MRI scans]. Rinsho Shinkeigaku 2016; 56:98-103. [PMID: 26797485 DOI: 10.5692/clinicalneurol.cn-000821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A 64-year-old man developed right arm weakness and dysarthria, and was admitted to our hospital. Diffusion-weighted magnetic resonance imaging of the brain showed a high intensity area in the frontal lobe. T2*-weighted images showed multiple spotty low intensity lesions in bilateral cerebral hemispheres, mimicking cerebral microbleeds. Cerebral angiography showed multiple aneurysms in the anterior, middle, posterior cerebral arteries and cerebellar arteries. Transthoracic echocardiography revealed a floating structure in the left atrial chamber, indicating cardiac myxoma. We diagnosed cardioembolic ischemic stroke due to left atrial myxoma. Cardiac surgery for excision of a left atrial myxoma was performed on the 3rd hospital day. Multiple aneurysms should be taken into account for differential diagnosis in patients with cardiac myxoma and with atypical spotty low intensity on T2*-weighted images.
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Affiliation(s)
- Takahiro Sato
- Department of Stroke Medicine, Kawasaki Medical School
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3
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Xu Q, Zhang X, Wu P, Wang M, Zhou Y, Feng Y. Multiple intracranial aneurysms followed left atrial myxoma: case report and literature review. J Thorac Dis 2014; 5:E227-31. [PMID: 24416521 DOI: 10.3978/j.issn.2072-1439.2013.11.27] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/11/2013] [Indexed: 12/26/2022]
Abstract
Cerebral aneurysms follows atrial myxoma is a rare neurological complication. We report a patient with multiple cerebral aneurysms three years after resection of left atrial myxoma and further review the literature. The characteristics of these aneurysms are indefinite and variable. They can occur prior or post the resection of cardiac myxoma. "Metastasize and Infiltrate" theory may be the key mechanism in the formation of these aneurysms. Magnetic resonance imaging (MRI), computed tomography (CT) and angiography are useful in the diagnosis while digital subtraction angiography (DSA) is the best choice. There are no definite guidelines for therapy of these aneurysms. Resection of the cardiac myxomas, chemotherapy, radiotherapy, coil embolization and surgical treatment could be helpful.
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Affiliation(s)
- Qingsheng Xu
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
| | - Xiaobing Zhang
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
| | - Pan Wu
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
| | - Ming Wang
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
| | - Yongqing Zhou
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
| | - Yiping Feng
- Department of Neurosurgery, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, P.R. China
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Ivanović BA, Tadić M, Vraneš M, Orbović B. Cerebral aneurysm associated with cardiac myxoma: Case report. Bosn J Basic Med Sci 2011; 11:65-8. [PMID: 21342146 DOI: 10.17305/bjbms.2011.2629] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Left atrial myxomas are a rare but well known cause of cerebrovascular accidents in young people. Cerebral embolism is the most common cause of cerebral ischemic stroke. The intracranial aneurysm is rarely associated with myxoma. We report the case of a patient who had an operation of PICA aneurysm due to subarachnoid hemorrhage ten months before the discovery of the large left atrial myxoma. Fortunately, the untimely diagnosis of the myxoma did not have other consequences. In order to prevent possible complications of we should keep in mind that these two apparently different entities could be associated.
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Affiliation(s)
- Branislava A Ivanović
- University of Belgrade, Faculty of Medicine, Department of Internal Medicine, Doktora Subotica, Belgrade, Serbia.
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5
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De Marco A, La Tessa G, De Falco A, De Falco F, Merola A, Sirabella G. Multiple Cerebral Aneurysms Associated with Atrial Myxoma. Neuroradiol J 2010; 23:62-8. [DOI: 10.1177/197140091002300111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2009] [Accepted: 09/27/2009] [Indexed: 11/16/2022] Open
Abstract
Cardiac myxoma is a tumor of mesenchymal origin accounting for half of all primary cardiac neoplasms. Intracranial involvement by atrial myxoma is a rare cause of neurologic deficit. When the myxoma arises in the left atrium, systemic emboli from a cardiac myxoma can lead to infarction, cerebral hemorrhage and aneurysm formation. In the light of the potentially preventable nature of these lesions, the diagnosis of myxomatous aneurysms should be considered in any patient with neurologic symptoms and a history of cardiac myxoma. Because aneurysms are often stable over several years, conservative management with careful clinical and radiological follow-up with MRI and angiography seems sensible. We describe a case in which MR imaging and angiography were used to diagnose multiple cerebral aneurysms caused by left atrial myxoma.
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Affiliation(s)
- A. De Marco
- Department of Neuroradiology, Santa Maria di Loreto Nuovo Hospital; Naples, Italy
| | - G. La Tessa
- Department of Neuroradiology, Santa Maria di Loreto Nuovo Hospital; Naples, Italy
| | - A. De Falco
- Department of Neurology, Santa Maria di Loreto Nuovo Hospital; Naples, Italy
| | - F.A. De Falco
- Department of Neurology, Santa Maria di Loreto Nuovo Hospital; Naples, Italy
| | - A. Merola
- Department of Neuroradiology, Santa Maria di Loreto Nuovo Hospital; Naples, Italy
| | - G. Sirabella
- Department of Neuroradiology, Santa Maria di Loreto Nuovo Hospital; Naples, Italy
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Anda T, Haraguchi W, Miyazato H, Tanaka S, Ishihara T, Aozasa K, Nakamichi I. Ruptured distal middle cerebral artery aneurysm filled with tumor cells in a patient with intravascular large B-cell lymphoma. J Neurosurg 2008; 109:492-6. [DOI: 10.3171/jns/2008/109/9/0492] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe a very rare case of intravascular large B-cell lymphoma in a woman whose ruptured distal middle cerebral artery (MCA) aneurysms were filled with lymphoma cells. A 69-year-old woman who had undergone artificial graft replacement for an aortic aneurysm presented with transient left hemiparesis. Magnetic resonance imaging demonstrated a small fresh cerebral infarction in the right frontal lobe, although major cervical and cerebral arteries were shown to be intact on MR angiography. Antiplatelet and anticoagulation treatments commenced. On the 21st day after onset, the patient suffered a subarachnoid hemorrhage, and a digital subtraction angiogram revealed aneurysmal lesions in the distal MCA. Based on the histological examination of the resected aneurysms, proliferation of large B-cell lymphoma was identified in the dilated arterial lumen. On the 71st day after ischemic onset, intracranial hemorrhage recurred, and she died. Postmortem examination revealed similar lymphoma cells only in the intimal layer that had grown on the artificial graft, and it was decided that the patient had had intravascular large B-cell lymphoma. The preceding cerebral infarction was thought to be due to occlusion of the distal MCA by tumor embolus, which may be the initial pathological stage in aneurysm formation. For patients with incomprehensible ischemic cerebral stroke, neoplasm must be taken in consideration.
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Affiliation(s)
| | | | - Hajime Miyazato
- 2Internal Medicine, Syunan Memorial Hospital, Kudamatsu, Yamaguchi
| | - Shinsuke Tanaka
- 3First Department of Pathology, Yamaguchi University School of Medicine, Ube, Yamaguchi; and
| | - Tokuhiro Ishihara
- 3First Department of Pathology, Yamaguchi University School of Medicine, Ube, Yamaguchi; and
| | - Katsuyuki Aozasa
- 4Department of Pathology (C3), Osaka University Medical School, Suita, Osaka, Japan
| | - Itsuko Nakamichi
- 4Department of Pathology (C3), Osaka University Medical School, Suita, Osaka, Japan
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Sedat J, Chau Y, Dunac A, Gomez N, Suissa L, Mahagne MH. Multiple cerebral aneurysms caused by cardiac myxoma. A case report and present state of knowledge. Interv Neuroradiol 2007; 13:179-84. [PMID: 20566147 DOI: 10.1177/159101990701300209] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2007] [Accepted: 04/30/2007] [Indexed: 12/13/2022] Open
Abstract
SUMMARY A case of multiple cerebral aneurysms caused by left atrial myxoma is reported.We present the details of this case and discuss the hypothetical pathogenesis, radiological aspects and treatment of these neoplastic aneurysms.
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Affiliation(s)
- J Sedat
- Unité de Neuroradiologie Interventionnelle CHU Nice, France -
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Sabolek M, Bachus-Banaschak K, Bachus R, Arnold G, Storch A. Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: a case report and review. Acta Neurol Scand 2005; 111:345-50. [PMID: 15876333 DOI: 10.1111/j.1600-0404.2005.00413.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Left cardiac myxoma and also consecutive embolization into the brain is well documented, whereas the association of myxomas with multiple fusiform cerebral aneurysms is rare. We analyze 33 previously reported patients and present a case of a 43-year-old woman with multiple cerebral infarctions 2 years after resection of a recurrent myxoma in the left atrium. Cerebral angiography displayed multiple fusiform aneurysms of several cerebral arteries, including a giant aneurysm of the basilar artery. Serum level of interleukin-6 (IL-6) was highly elevated. The clinical, radiological and pathological features of these aneurysms are summarized. The pathogenesis, including the role of IL-6 in the formation of myxomatous aneurysms, is discussed.
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Affiliation(s)
- M Sabolek
- Department of Neurology, University of Ulm, Ulm, Germany
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El aneurisma cerebral en la evolución del mixoma cardíaco: planteamientos clínicos y fisiopatológicos. RADIOLOGIA 2003. [DOI: 10.1016/s0033-8338(03)77921-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Moreno Izarra J, Romero López A, Pinillos Villatoro D, Delgado Acosta F, Fernández de la Puebla R, Pérez Jiménez F. [Focal seizures in a young man with long term arthromyalgia and recurrent skin lesions. Cardiac myxoma. Neoplastic aneurysm and multiple cerebral infarct due to tumor embolization]. Rev Clin Esp 2000; 200:487-8. [PMID: 11111394 DOI: 10.1016/s0014-2565(00)70702-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- J Moreno Izarra
- Servicios de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba
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