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Cerebral embolism from atrial myxoma in pediatric patients
Majeed Al-Mateen1, Margaret Hood, Don Trippel
1Pediatric Neurology Clinic, Mary Bridge Children's Hospital and Health Center, Tacoma, Washington 98415, USA. majeed.al-mateen@muticare.org
Insights
Left atrial myxomas can cause cerebrovascular events in children, often preceded by skin eruptions. Early diagnosis and surgical removal of these tumors are crucial for a cure.
Area of Science:
- Pediatric Neurology
- Cardiovascular Pathology
- Oncology
Background:
- Atrial myxomas are rare primary cardiac tumors.
- Cerebrovascular events in children can have various etiologies.
- Peripheral embolization from cardiac tumors is a known complication.
Observation:
- Two pediatric cases of cerebrovascular events secondary to left atrial myxomas are presented.
- A review of seven additional pediatric cases from existing literature is included.
- Transient cutaneous eruptions on extremities preceded neurological events in some cases, suggesting tumor fragmentation and embolization.
Findings:
- Cerebrovascular events included acute hemiplegia due to cerebral infarction and transient ischemic attacks from vertebrobasilar involvement.
- Neither patient had prior cardiac history or symptoms.
- Atrial myxoma should be considered in pediatric patients presenting with neurological deficits or embolic phenomena.
Implications:
- Early recognition of atrial myxoma is vital in pediatric neurology.
- Prompt surgical intervention for atrial myxoma can be curative.
- This highlights the importance of considering cardiac sources for embolic events in children.
Abstract:
We describe 2 children with cerebrovascular events caused by emboli from left atrial myxomas and review 7 other pediatric cases from the literature. Transient cutaneous eruptions involving the extremities preceded the cerebrovascular events and were most likely attributable to fragmentation of the atrial tumor with peripheral embolization. Our first case demonstrates the more common presentation with acute hemiplegia caused by cerebral infarction and the second case a transient ischemic attack manifested by more subtle features as a result of involvement of the vertebrobasilar circulation. Neither child had a history or other signs of cardiac disease. Atrial myxoma should be considered in the differential diagnosis when children present with neurologic symptoms or with signs of embolization, because surgical removal of the tumor is critical and may be curative.