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Heart or head?: A depression mimic delays diagnosis-oncotic cerebral aneurysms caused by atrial myxoma
Bridgid Connolly1, Simon J Prowse2, Catherine E Connolly2
1Radiology Department, Flinders Medical Centre, Adelaide, South Australia.
Insights
A rare case of left atrial myxoma caused multiple brain aneurysms. Surgical removal of the cardiac tumor is crucial to prevent further embolic complications and improve patient outcomes.
Area of Science:
- Cardiology
- Neurology
- Oncology
Background:
- Intracardiac tumors, particularly cardiac myxomas, can lead to severe complications, including embolic events.
- Cerebral aneurysms are a rare but significant manifestation of cardiac myxoma, posing a risk of hemorrhage and stroke.
Observation:
- This case report details a female patient presenting with multiple oncotic intracranial aneurysms secondary to a left atrial myxoma.
- The patient's clinical presentation was potentially non-specific, underscoring the challenges in early diagnosis.
Findings:
- Cardiac myxoma can manifest with diverse clinical symptoms, including neurological deficits due to embolic phenomena.
- Multimodality imaging, with a pivotal role for cardiac MRI, is essential for diagnosing cardiac myxoma and associated aneurysms.
- Surgical excision of the cardiac mass is mandatory for symptomatic relief and prevention of further embolic events.
Implications:
- Early and accurate diagnosis of atrial myxoma is critical to prevent devastating neurological complications.
- Multidisciplinary collaboration is essential for effective management and improved prognosis in patients with cardiac myxoma and associated aneurysms.
- Long-term patient follow-up is necessary due to the risk of local recurrence and delayed cerebral complications.
Abstract:
Complications of intracardiac tumours can carry significant morbidity and mortality. This article depicts the case of a female who presented with multiple oncotic intracranial aneurysms secondary to a left atrial myxoma. The clinical manifestations and pathogenesis of cardiac myxoma, as well as the imaging pathway, management and prognosis of myxomatous aneurysms will be discussed. Excision of the cardiac mass is mandatory both for symptomatic improvement and to prevent further embolic complications. Local recurrence and delayed onset cerebral complications do occur, and necessitate ongoing patient follow-up. Our report highlights several important features of the diagnostic and treatment pathway for atrial myxoma-in particular, the potentially non-specific clinical presentation, the pivotal role of cardiac MRI in the multimodality diagnostic imaging work up and the need for multidisciplinary communication to identify the diagnosis and guide appropriate management.
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