Cerebellar embolization in patients with heart murmur

Area of Science:

• Cardiology
• Neurology
• Pathology

Background:

• Atrial myxomas are rare primary cardiac tumors, often asymptomatic but can cause embolic events.
• Cerebellar infarction, presenting with symptoms like dizziness and dysarthria, can be caused by cardioembolic sources.
• Hypertension and atrial fibrillation are common comorbidities that increase stroke risk.

Observation:

• A 76-year-old female presented with acute neurological deficits including dysarthria and dizziness.
• Imaging revealed a right cerebellar infarction and a large, mobile mass in the left atrium attached to the interatrial septum.
• Coronary angiography identified feeding arteries originating from the right coronary artery supplying the left atrial mass.

Findings:

• Transesophageal echocardiography visualized a large, complex, echogenic, round mass in the left atrium.
• Pathological examination after surgical excision confirmed the mass to be a myxoma.
• The myxoma was identified as the source of the embolic event leading to cerebellar infarction.

Implications:

• This case highlights the importance of investigating embolic stroke causes, including cardiac tumors like myxoma.
• Early diagnosis and surgical intervention are crucial for preventing further embolic events and improving patient outcomes.
• The unusual vascular supply to the myxoma from the coronary artery warrants further investigation in similar cases.