Cerebrovascular Accident: An Initial Presentation of Atrial Myxoma in a Young Female - Cureus

The diligent is simply a 35-year-old pistillate with a past of fibromyalgia and Charcot-Marie-tooth illness who presented to the exigency section with complaints of a 10-hour past of left-sided facial driblet and left-hand numbness. Facial droop and manus numbness began astatine the aforesaid clip but progressively worsened. She denied dizziness, nonaccomplishment of consciousness, past of falls and caput trauma, changes successful imaginativeness and speech, oregon trouble swallowing. She besides denied seizures, use of oral contraceptive pills, oregon a household past of CVA and clot formation. She admitted to occasional marijuana use, smoking a battalion of cigarettes per time for 15 years, and drinking 5 alcoholic drinks per day, with her past portion 4 days earlier the presentation. The surgical past was important for a cesarean conception 11 years prior. There was nary past of allergies. Vital signs were notable for tachycardia, with a bosom complaint of 123 bpm and humor unit of 138/97 mmHg. Physical introspection revealed mean cardiovascular and pulmonary examinations, but was affirmative for left-sided facial driblet and 3/5 weakness successful the near precocious extremity. Laboratory results were hemoglobin 17.9 and antagonistic troponin elevation. Blood chemistries were glucose of 138, with somewhat deranged liver enzymes specified arsenic aspartate transaminase 67, alanine transaminase 63, and alkaline phosphatase 130. Urine investigation showed the beingness of humor and traces of bilirubin, portion the urine toxicology trial was affirmative for cannabinoids. A thorax x-ray showed resolving pulmonary edema and near basilar atelectasis. The EKG done was unremarkable. A contrast-free CT scan of the encephalon revealed tiny hypodense areas of acute and subacute infarcts successful the anterior close frontal and parietal lobes (Figure 1). MRI showed tiny scattered multifocal lesions of acute and subacute infarctions wrong bilateral cerebral hemispheres and the close parietal lobe (Figure 2). The echocardiogram showed a preserved ejection fraction (EF) of 60-65% with a ample wide successful the near atrium measuring 35 × 35 mm, suggestive of a myxoma (Figures 3, 4). The diagnosis of little extremity embolization was ruled retired with the usage of little extremity angiography. Since the diligent was extracurricular the model for thrombolytics, she was started connected dual antiplatelet therapy. The diligent subsequently had a median sternotomy for resection of the near atrial myxoma. Post-surgery echo was antagonistic for myxoma (Figure 5). Neurological deficits continued to amended in-patient and were wholly resolved astatine the clip of discharge. The excised wide was confirmed by the pathologist to beryllium a myxoma. 

In a survey by the Mayo Clinic, of 74 patients diagnosed with atrial myxoma, 12% had neurological complications, and lone 7 patients successful the cohort had neurological symptoms arsenic the archetypal manifestations of atrial myxoma [3]. Although atrial myxomas are much communal successful women, females bash not usually contiguous with distant clot formations originating from myxomas; conversely, men are much apt to person systemic embolization. It is besides important to enactment that the size of the myxoma affects the embolization rates. In different words, the smaller the myxoma, the much apt it would embolize. A lit reappraisal reveals that immoderate size smaller than oregon adjacent to 4.5 cm has a higher propensity for systemic embolization. Cardiac myxomas whitethorn origin symptoms either due to the fact that of intracardiac obstruction, systemic embolism of tumor fragments, oregon law symptoms owed to unclear mechanisms. The astir feared consequences of cardiac myxomas are preoperative systemic embolism and myxoma recurrence aft surgical resection [4]. Of note, our diligent had a myxoma dimension of 35 mm × 35 mm, thereby expanding her accidental of embolization.

The mean property of atrial myxoma is 56 years for sporadic cases and 25 years for familial cases. The mean property astatine presumption was 37.1 years. Dyspnea was the astir communal symptom. Embolism was recovered successful 9% of patients and systemic symptoms successful 20% of patients [5]. The near atrium is the preferable location, astir apt constituting up to 60-80% of each myxomas, and the remaining cases of myxomas tin hap successful the close atrium, close ventricle, oregon near ventricle and adjacent immoderate are bi-atrial [6]. Our diligent was 35 years aged without immoderate cardiovascular symptoms and had nary household past of intracardiac tumors. It besides appears that her archetypal presumption was a CVA. In summation to the comparative rarity of atrial myxoma, the uncommon quality of embolization successful females and the predisposition of the tumors successful middle-aged oregon aged adults marque it indispensable to person a precocious scale of suspicion erstwhile caring for females who make cerebrovascular accidents. It is important to see this arsenic a differential due to the fact that if these myxomas are not recognized early, they tin pb to tremendous morbidity and mortality, particularly successful patients who bash not contiguous with cardiovascular symptoms oregon hazard factors.