Neurologic symptoms as first manifestation of primary cardiac tumors

Primary cardiac tumors are very infrequent, usually benign, and occasionally present with neurological symptoms.

We retrospectively analyzed a series of 107 patients diagnosed of primary cardiac tumors who underwent cardiac surgery between 1994 and 2024.

Stroke was the debut form of tumor in 14 patients. Multiple ischemic lesions on neuroimaging were identified in 50% of patients, but no aneurysms or brain tumor metastases were observed at the time of diagnosis. Neurological symptoms were more frequent in patients with villous tumors (33.3 vs. 7.2%) (p=0.001), regardless of tumor diameter. In the multivariate analysis, patients with neurological debut presented NYHA I functional class (RR: 11.9; 95% CI [2.3-60.5]; p=0.003) and villous tumor morphology (RR: 6.78; 95% CI [1.8-25.3]; p=0.004). No patient underwent reperfusion treatment and surgical excision of the tumor was performed (median stroke-surgery: 19 days) without early postoperative or late neurological complications during follow-up.

Neurological symptoms can be the first manifestation of primary cardiac tumors in patients with good functional class and a history of multiple peripheral embolisms. Villous morphology favors neurological manifestations of embolic origin, despite tumor size. Late neurological complications, due to brain aneurysms or tumor metastases, are extremely rare and have not seen in our series.