Embolic stroke due to atrial myxoma: about a case

Abstract

Cardiac myxoma is recognized as the most common primary cardiac tumor, typically benign, slow-growing, with a predilection for the left atrium, presenting as a mobile mass attached to the inner surface of the heart by a peduncle. Although its presentation through cerebrovascular events is quite common, it remains an exceedingly rare cause, representing approximately 0.5% of all cerebrovascular events. In this clinical case, we describe a 54-year-old woman with no significant medical history who presented with embolization in both cerebral hemispheres without specific neurological deficits. A left atrial mass was identified on echocardiography. Given the risk of further systemic embolization, the patient underwent surgical excision of the left atrial mass, which histopathology confirmed to be a cardiac myxoma. Due to the high recurrence of systemic embolic events, particularly in the form of cerebral ischemic embolisms, the diagnosis of cardiac myxoma should prompt immediate surgical intervention, as the tumor's friability is more closely related to the embolic risk than its size or the presence of concomitant cardiovascular risk factors. Surgical resection is generally curative and the recurrence of new cerebrovascular events is rare, with an excellent prognosis, although recurrence of tumor is possible in cases of inadequate resection. Treatment with antiplatelet agents or anticoagulants is not an alternative to surgery, as cerebrovascular events can occur even under such treatments.