Cerebral Infarction due to Cardiogenic Emboli Originating from Atrial Myxoma: A Case Report

Abstract

Cardiogenic embolism due to atrial myxoma is a rare cause of cerebral infarction. A 51-year-old woman presented to a hospital elsewhere with sudden onset of vision loss, loss of consciousness and subsequent circulatory collapse. Computed tomography and magnetic resonance imaging of brain revealed a rostral brainstem infarction, cerebral angiography showed evidence of occlusion of the left posterior cerebral artery, and echocardiographic examination revealed the presence of a mass in the left atrium. The patient received palliative care and was discharged. Four months later, she presented with muscle weakness in both legs and was unable to walk. Ultrasonography revealed atherosclerotic plaques in the left and right carotid arteries and multiple segmental emboli in the lower extremities. In addition, physical examination revealed bilateral blepharoptosis, poor pupillary reaction to light, deficient upward and downward eye movements and limited adduction. Anticoagulants and blood-lipid lowering drugs were administered. Auscultation of the precordium revealed systolic murmurs when the patient was in a sitting position. Echocardiographic examination and computed tomography of the chest disclosed a mass in the left atrium. The patient underwent surgical resection of the atrial mass. Histopathological examination of the resected tumor revealed a glandular cardiac myxoma. At four-month follow-up, there was some improvement in neurological symptoms. A cardiac origin of cerebral infarction should be suspected in middleaged patients who present with cardiac myxoma. Early surgical resection of the cardiac myxoma is important to prevent further embolic events.