Abstract
From 1980 to 1992 we followed 12 patients with cardiac myxomas for an average of 4.4 years (8 months–11 years). Presenting symptoms were neurological in four patients (hemiparesis, aphasia, visual field deficits, progressive dementia or vertigo), progressive dyspnoea in six, pulmonary embolism in one, and peripheral arterial or renal emboli in three. The diagnosis was suspected clinically in 11 patients. It was confirmed by echocardiography in ten and by thoracic CT in one. All these patients had cardiac surgery. One diagnosis was made at autopsy; the patient died unexpectedly during surgery for emboli to the leg arteries. At follow-up, two additional patients had died, one from myocardial infarction and one from rhabdomyosarcoma. Only one of the nine surviving patients had recurrent symptoms after cardiac surgery. His dementia continued to progress. The patients without new symptoms after cardiac surgery had normal MRI of the brain or residual ischaemic lesions. MRI of the patient with progressive dementia showed multiple cerebral lesions with a bright centre and a dark rim on T1- and T2-weighted spin-echo images. On CT there were many calcified lesions. CT, MR angiography and contrast angiography revealed multiple fusiform aneurysms. The rare occurrence of progressive neurological symptoms after myxoma resection with multiple cerebral lesions and aneurysms should suggest myxoma metastases to the brain.
Similar content being viewed by others
References
Greenwood WF (1968) Profile of artrial myxoma. Am J Cardiol 21: 367–375
Peters MN, Hall RJ, Cooley DA, Leachman, Garcia E (1974) The clinical syndrome of atrial myxoma. JAMA 230:695–701
Bulkley BH, Hutchins GM (1979) Atrial myxomas: a fifty years review. Am Heart J 97: 639–643
Calanchini PR (1979) Cardiac myxoma. In: Vinken PJ, Brunn PW (eds) Handbook of neurology, vol 38. North Holland, Oxford, pp 173–192
Knepper LE, Bill J, Adams HP Jr, Bruno A (1988) Neurologic manifestation of atrial myxoma. A 12-year experience and review. Stroke 19: 1435–1440
Schmid C, Paterakis S, Likungu JA, Kirchhoff PG (1988) Cardiac myxoma. Clinical and pathologic features in 15 cases. Klin Wochenschr 66: 713–717
Reichmann H, Romberg-Hahnloser R, Hofmann E, Becker T, Mertens HG (1992) Neurological longterm followup in left atrial myxoma: are late complications frequent or rare? J Neurol 239:170–174
Scully RE, Mark EJ, McNeely WF, McNeely BU (1993) Case records of the Massachusetts General Hospital, case 9-1993. N Engl J Med 328: 640–647
MacGregor GA, Cullen RA (1959) The syndrome of fever, anemia and high sedimentation rate with an atrial myxoma. BMJ 2: 991–993
Currey HLF, Mathews JA, Robinson J (1967) Right atrial myxoma mimicking a rheumatic disorder. BMJ 1: 547–548
Kaminsky ME, Ehlers KH, Engle MA, Klein AA, Levin AR, Subramanian VA (1979) Atrial myxoma mimicking a collagen disorder. Chest 75: 93–95
Huston KA, Combs JJ Jr, Lie JT, Giuliani ER (1978) Left atrial myxoma simulating peripheral vasculitis. Mayo Clin Proc 53: 752–756
Wens R, Goffin Y, Pepys MB, et al (1989) Left atrial myxoma associated with systemic AA amyloidosis. Arch Intern Med 149: 453–454
Leonhardt ETG, Kullenberg KP-G (1977) Bilateral atrial myxomas with multiple arterial aneuryms — a syndrome mimicking polyarteritis nodosa. Am J Med 62: 792–794
Savige JA, Yeung SP, Davies DJ, Ebeling P, Hunt DH (1988) Antineutrophil cytoplasmic antibodies associated with atrial myxoma. Am J Med 85:755–756
Bataille R, Jourdan M, Séguin J, Zhang XG, Chaptal PA, Klein B (1990) Constitutive production of interleukin-6 and immune features in cardiac myxomas. Arthritis Rheum 33: 398–402
Séguin JR, Beigbeder JY, Hvass U, et al (1992) Interleukin 6 production by cardiac myxomas may explain constitutional symptoms. J Thoracic Cardiovasc Surg 103: 599–600
Roeltgen DP, Weimer GR, Patterson LF (1981) Delayed neurologic complications of left atrial myxoma. Neurology 31: 8–13
Browne WT, Wijdicks EFM, Parisi JE, Viggiano RW (1993) Fulminant brain necrosis from atrial myxoma showers. Stroke 24: 1090–1092
Rankin LI, DeSousa AL (1978) Metastatic atrial myxoma presenting as intracranial mass. Chest 74: 451–452
Seo IS, Warner TFCS, Colyer RA, Winnkler RF (1980) Metastasizing atrial myxoma. Am J Surg Pathol 4: 391–399
Todo T, Usui M, Nagashima K (1992) Cerebral metastasis of malignant cardiac myxoma. Surg Neurol 37: 374–379
Ng HK, Poon WS (1990) Cardiac myxoma metastasizing to the brain. Case report. J Neurosurg 72: 295–298
Japanese Pathological Society (1988) Annual of the pathological autopsy cases in Japan 30: 1513–1530 (quoted in Todo et al, Surg Neurol 1992; 37: 374–379)
New PFJ, Price DL, Carter B (1970) Cerebral angiography in cardiac myxoma: correlation of angiographic and histopathological findings. Radiology 96:335–345
Desouza AL, Muller J, Campbell RL, Batnitzky S, Rankin L (1978) Atrial myxoma: a review of the neurological complications, metastases, and recurrences. J Neurol Neurosurg Psychiatry 41:1119–1124
Stoane L, Allen JH Jr, Collins HA (1966) Radiologic observations in cerebral embolization from left heart myxomas. Radiology 87: 262–266
Burton C, Johnston J (1970) Multiple cerebral aneurysms and cardiac myxoma. N Engl J Med 282: 35–36
New PFJ (1970) Myxomatous emboli in the brain. N Engl J Med 282: 396
Steinmetz EF, Calanchini PR, Aguilar M (1973) Left atrial myxoma as a neurological problem: case report and review. Stroke 4: 451–458
Price DL, Harris JL, New PFJ, et al (1970) Cardiac myxoma: a clinicopathologic and angiographic study. Arch Neurol 23: 558–567
Damasio H, Seabra-Gome R, da Silva JP, Damasio AR, Antunes JL (1975) Multiple cerebral aneurysms and cardiac myxoma. Arch Neurol 32: 269–270
Michael AS, Mikhael MA, Christ M (1989) Myxoma of the heart presenting with recurrent episodes of hemorrhagic cerebral infarction: MR findings. J Comput Assist Tomogr 13: 123–125
Markel ML, Waller BF, Armstrong WF (1987) Cardiac myoma. Medicine 66: 114–125
Macaulay VM, Crawford PJ, McKeran RO (1985) Atrial myxoma presenting with cerebral hemorrhage. Postgrad Med J 61: 333–334
Patte M, Rakofsky M, Telerman M, Struyver S, Demeurisse G, Levi S (1973) Myxome de l'oreille gauche découvert grâce à l'angiographie cérébrale. Acta Neurol Belg 73: 252–263
Branch CL, Laster DW, Kelly DL (1985) Left atrial myxoma with cerebral emboli. Neurosurgery 16: 675–680
Marazuela M, Garcia-Merino A, Yebra M, Brasa JM, Diego J, Duràntez A (1989) Magnetic resonance imaging and angiography of the brain in embolic left atrial myxoma. Neuroradiology 31: 137–139
Jungreis CA, Sekhar PR, Martinez AJ, Hirsch BE (1989) Cardiac myxoma metastatic to the temporal bone. Radiology 170: 244
Suzuki T, Nagai R, Yamazaki T, et al (1994) Rapid growth of intracranial aneurysms secondary to cardiac myxoma. Neurology 44: 570–571
Frank RA, Shalen PR, Harvey DG, Berg L, Ferguson TB, Schwartz HG (1979) Atrial myxoma with intellectual decline and cerebral growths on CT scan. Ann Neurol 5: 396–400
Kadota T, Imakiia S, Mitomo M, et al (1987) Metastatic brain tumor of atrial myxoma. Neuroradiology 29: 218
Hofmann E, Becker T, Romberg-Hahnloser R, Reichmann H, Warmuth-Metz M, Nadjimi M (1992) Cranial MRI and CT in patients with left atrial myxoma. Neuroradiology 34: 57–61
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Mattle, H.P., Maurer, D., Sturzenegger, M. et al. Cardiac myxomas: a long term study. J Neurol 242, 689–694 (1995). https://doi.org/10.1007/BF00866921
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00866921