Early and delayed neurological manifestations of cardiac myxomas

Leonidas D Panos; Christophe Brunel; Sabina Berezowska; Renate Engisch; Attila Kollar; Claudio Bassetti; Mathias Sturzenegger; Heinz Krestel

doi:10.1016/j.clineuro.2020.105673

Early and delayed neurological manifestations of cardiac myxomas

Clin Neurol Neurosurg. 2020 Mar:190:105673. doi: 10.1016/j.clineuro.2020.105673. Epub 2020 Jan 7.

Authors

Leonidas D Panos¹, Christophe Brunel², Sabina Berezowska³, Renate Engisch⁴, Attila Kollar⁵, Claudio Bassetti⁶, Mathias Sturzenegger⁶, Heinz Krestel⁷

Affiliations

¹ Departments of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland. Electronic address: Leonidas.panos@insel.ch.
² Institute of Pathology, University Hospital Center and University of Lausanne, Lausanne, Switzerland.
³ Institute of Pathology, University of Bern, Bern, Switzerland.
⁴ Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland.
⁵ Departments of Oncology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland.
⁶ Departments of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland.
⁷ Departments of Neurology, Institute of Diagnostic and Interventional Neuroradiology, Bern University Hospital and University of Bern, Bern, Switzerland. Electronic address: heinz.krestel@insel.ch.

PMID: 31945622
DOI: 10.1016/j.clineuro.2020.105673

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.

Keywords: CRP; Fusiform aneurysm; Myxoma; Radiotherapy; Stellate cells.

Publication types

Case Reports

MeSH terms

Brain Neoplasms / diagnostic imaging
Brain Neoplasms / etiology*
Brain Neoplasms / pathology
C-Reactive Protein / metabolism
Cerebral Hemorrhage / diagnostic imaging
Cerebral Hemorrhage / etiology
Embolic Stroke / diagnostic imaging
Embolic Stroke / etiology*
Heart Neoplasms / complications*
Heart Neoplasms / metabolism
Heart Neoplasms / pathology
Humans
Intracranial Aneurysm / diagnostic imaging
Intracranial Aneurysm / etiology*
Magnetic Resonance Imaging
Male
Middle Aged
Myxoma / complications*
Myxoma / diagnostic imaging
Myxoma / metabolism
Myxoma / pathology
Neoplastic Cells, Circulating / pathology*

Substances

C-Reactive Protein