Atrial myxoma presenting with cerebral haemorrhage

Emboli from left atrial myxomas are a recognized cause of cerebral ischaemia. The myxomatous embolus may infiltrate the cerebral arterial wall, resulting in aneurysmal dilatation with a risk of rupture. Myxoma-associated cerebral haemorrhage has been described in patients with progressive neurological dysfunction. We report a new presentation. Our patient, a previously healthy 20 year old girl, developed acute intracerebral haemorrhage for which craniotomy was performed. Histology of evacuated haematoma revealed an intravascular fragment of myxoma. Echocardiography demonstrated a left atrial myxoma which later was uneventfully excised. Early diagnosis of embolic cardiac myxoma requires awareness of the diversity of clinical manifestations, and careful histological analysis of surgical specimens.