Myxomatous Aneurysms Research Articles

Oncotic (Myxomatous) Aneurysms: A Review of Management

AbstractAtrial myxomas are the most common primary cardiac tumors and may manifest with neurological symptoms in ∼ 30% of cases. Cerebral ischemia, aneurysmal formation, and extravascular metastases are mechanisms that lead to these neurological manifestations. Perilesional changes on computed tomography (CT) and magnetic resonance imaging (MRI) may help in the diagnosis of myxomatous aneurysms, which are usually located in the distal middle cerebral artery (MCA) and in the posterior cerebral artery (PCA) circulation territories. Careful resection of the cardiac lesion is essential for preventing embolism. However, treatment of myxomatous aneurysms is controversial due to the limited understanding of the natural history of this condition. Treatment may include clinical observation in asymptomatic patients, surgical resection, endovascular approaches, adjuvant chemotherapy, and low-dose radiation therapy. We present one case of a female patient with myxomatous aneurysm secondary to an atrial myxoma who presented with neurological symptoms and another case of a female patient who developed neurological symptoms after initial surgical treatment of the primary lesion. Lesion growth rate, topography, morphology, and the patient's clinical condition must be considered when choosing a therapeutical method. Further clinical studies are needed to achieve a better understanding and treatment of this disease.

Neurological Complications of Cardiac Tumors.

This article reviews recent literature regarding the neurological manifestations of cardiac tumors, including diagnosis, pathophysiology, and treatment. Clinical cases of patients with acute ischemic stroke due to cardiac tumors who were treated with intravenous alteplase show a favorable safety profile. Mechanical thrombectomy seems to be a reasonable treatment alternative for these patients, when there is a large vessel occlusion. Histopathology analysis of mechanical thrombectomy specimens may allow the diagnosis of a cardiac tumor. Prolonged time interval between stroke and tumor excision surgery is significantly associated with stroke recurrence. Myxomatous aneurysms are a late complication of cardiac myxomas, which commonly demand imaging follow-up after excision of the primary tumor. Aneurysms are more frequent in patients who present with other embolic complications. Conservative treatment of myxomatous aneurysms is a reasonable strategy, as the majority of aneurysms remain stable over many years. Spontaneous regression of these formations has been documented after excision of the primary tumor. Other complications recently described include acute psychosis and mononeuropathy multiplex. Cardiac tumors are rare. There are mainly case reports and retrospective case series describing the neurological manifestations of cardiac tumors. Hyperacute stroke treatment seems to be safe, and mechanical thrombectomy is a reasonable treatment. A conservative approach towards myxomatous aneurysms should be considered.

Cerebral Myxomatous Aneurysm Treated by M2-M2 Bypass: A Case Report

Cerebral Myxomatous Aneurysm Treated by M2-M2 Bypass: A Case Report

Cerebral Myxomatous Aneurysm Treated by M2-M2 Bypass: A Case Report

Cerebral Myxomatous Aneurysm Treated by M2-M2 Bypass: A Case Report

Rare Presentation of Malignant Myxomatous Aneurysms with PRKAR1A gene mutation (P2.243)

Rare Presentation of Malignant Myxomatous Aneurysms with PRKAR1A gene mutation (P2.243)

Neuroimaging Findings in Cardiac Myxoma Patients: A Single-Center Case Series of 47 Patients

Background and Purpose: Cardiac myxomas can present with a myriad of neurological complications including stroke, cerebral aneurysm formation and metastatic disease. Our study had two objectives: (1) to describe the neuroimaging findings of patients with cardiac myxomas and (2) to examine the relationship between a history of embolic complications secondary to myxoma and intracranial aneurysm formation, hemorrhage and metastatic disease. We hypothesized that patients who present with embolic complications related to myxoma would be more likely to have such complications. Materials and Methods: We searched our institutional database for all patients with pathologically proven cardiac myxomas from 1995 to 2014 who received neuroimaging. Neuroimaging findings were categorized as acute ischemic stroke, intracerebral hemorrhage, oncotic aneurysm, and cerebral metastasis. Cardiac myxoma patients were divided into those presenting with embolic complications (i.e. lower extremity emboli or cerebral emboli) and those presenting with non-embolic complications prior to surgical resection of the myxoma. The prevalence of intracranial hemorrhage, myxomatous aneurysm formation, and cerebral metastases was compared in myxoma patients presenting with and without embolic complications using a Chi-squared test. Results: Forty-seven consecutive patients were included in this study. Sixteen patients (34.0%) had imaging evidence of acute ischemic stroke. Of these, 13 had acute ischemic strokes directly attributed to the cardiac myxoma (27.7%) and 3 had acute ischemic strokes secondary to causes other than myxoma (6.4%). Seven patients (14.9%) had aneurysms. Two patients (4.3%) had parenchymal metastatic disease on long-term imaging. Fourteen patients (29.8%) presented with ischemic symptoms that were attributed to cardiac myxoma (1 with lower extremity ischemia, 1 with lower extremity ischemia and ischemic stroke, and 12 with ischemic stroke). Patients presenting with embolic complications related to the myxoma (ischemic stroke or lower extremity ischemia) were more likely to have imaging evidence of intracranial hemorrhage (21.4 vs. 3.0%, p = 0.09), oncotic aneurysm (35.7 vs. 6.1%, p = 0.03), and cerebral metastasis (14.3 vs. 0.0%, p = 0.07) on follow-up imaging. Conclusions: Ischemic stroke and intracranial oncotic aneurysm were found in a substantial proportion of cardiac myxoma patients undergoing neuroimaging. Patients presenting with embolic complications of cardiac myxoma are more likely to have intracranial hemorrhage, intracranial oncotic aneurysms, and cerebral metastatic disease.

The imaging features of neurologic complications of left atrial myxomas

BackgroundNeurologic complications may be the first symptoms of atrial myxomas. Understanding the imaging features of neurologic complications of atrial myxomas can be helpful for the prompt diagnosis. ObjectiveTo identify neuroimaging features for patients with neurologic complications attributed to atrial myxoma. MethodsWe retrospectively reviewed the medical records of 103 patients with pathologically confirmed atrial myxoma at Xiangya Hospital from January 2009 to January 2014. The neuroimaging data for patients with neurologic complications were analyzed. ResultsEight patients with atrial myxomas (7.77%) presented with neurologic manifestations, which constituted the initial symptoms for seven patients (87.5%). Neuroimaging showed five cases of cerebral infarctions and three cases of aneurysms. The main patterns of the infarctions were multiplicity (100.0%) and involvement of the middle cerebral artery territory (80.0%). The aneurysms were fusiform in shape, multiple in number (100.0%) and located in the distal middle cerebral artery (100.0%). More specifically, high-density in the vicinity of the aneurysms was observed on CT for two patients (66.7%), and homogenous enhancement surrounding the aneurysms was detected in the enhanced imaging for two patients (66.7%). ConclusionNeurologic complications secondary to atrial myxoma consist of cerebral infarctions and aneurysms, which show certain characteristic features in neuroimaging. Echocardiography should be performed in patients with multiple cerebral infarctions, and multiple aneurysms, especially when aneurysms are distal in location. More importantly, greater attention should be paid to the imaging changes surrounding the aneurysms when myxomatous aneurysms are suspected and these are going to be the relevant features in our article.

Multiple Cerebral Myxomatous Aneurysms: What Is the Optimal Treatment?

Multiple cerebral aneurysms resulting from cardiac myxoma is a very rare disease, and the optimal treatment is not yet determined. We present 2 cases of multiple cerebral myxomatous aneurysms and give an overview of the English literature pertaining to this disease. We described 2 new cases of multiple cerebral myxomatous aneurysms and performed a search of English literature in PubMed and Google Scholar. Keywords used were as follows (single word or combination): "neoplastic aneurysm," "oncotic aneurysm," "aneurysm," and "myxoma." Only patients with multiple cerebral aneurysms resulting from cardiac myxoma and contained adequate follow-up information pertinent to the analysis were included. One patient underwent craniotomy for resection of an aneurysm. Microscopic examination demonstrated the myxoma in the aneurysmal wall. The other patient was managed conservatively. Thirty-five cases meeting the previously mentioned criteria were found in the literature. This disease was typically diagnosed in young adults (median age = 38 years). Females were more frequently affected (F/M ratio, 2.7:1). A total of 78.4% were managed conservatively. A total of 16.2% underwent craniotomy for aneurysm resection and/or hematoma evacuation. At follow-up, 64.9% were stable, 10.8% revealed disappearance of aneurysms, 10.8% showed enlargement of aneurysms, and the mortality rate was 13.5%. Patients with multiple cerebral aneurysms should routinely be evaluated for cardiac myxoma and vice versa. Conservative treatment is recommended for most of the patients. Prognosis is good in most patients.

Management of multiple intracerebral hemorrhages due to myxomatous aneurysms — /INS;A case report and literature review

Management of multiple intracerebral hemorrhages due to myxomatous aneurysms — /INS;A case report and literature review

Emergency Excision of Cardiac Myxoma and Endovascular Coiling of Intracranial Aneurysm after Cerebral Infarction

Cardiac myxoma is the most common primary tumor of the heart, located mainly in the left atrium. Cerebral embolization or intracranial aneurysm formation as a consequence of left atrial myxomas has been well documented, whereas myxoma embolization causing the combination of cerebral infarction and intracranial myxomatous aneurysm is rare. We report herein, a 67-year-old female with a cardiac myxoma who experienced a left hemispheric embolic ischemic stroke and in addition was found to have right internal carotid artery aneurysm. The patient underwent emergency surgical excision of left atrial myxoma 2 hours after the stroke onset and endovascular coiling of the aneurysm a week later. Although the timing of cardiac surgery is controversial in patients who have had recent ischemic stroke, we recommend immediate resection of cardiac myxoma, if feasible, and early endovascular treatment of associated intracranial myxomatous aneurysms.

Complicated Sporadic Cardiac Myxomas: A Second Recurrence and Myxomatous Cerebral Aneurysms in One Patient

A second recurrence of an excised nonfamilial cardiac myxoma is rare. Myxomatous cerebral aneurysms as a complication of cardiac myxomas are equally rare. A unique case of a patient with a total of 4 myxomas over a 20-year interval is presented. Her most recent presentation was a second recurrence of a left atrial myxoma, a de novo right atrial myxoma, and multiple cerebral myxomatous aneurysms. The challenging reconstruction of the normal anatomy was achieved with the use of porcine extracellular matrix patches. A diagnostic cerebral angiogram was later performed, and the aneurysms will be monitored for growth and possible intervention.

Myxomatous Aneurysms

Cardiac myxomas are benign tumors that may lead to neurological manifestations including ischemic stroke, aneurysms or metastases. We describe a patient with multiple intracranial aneurysms who presented with TIA-like symptoms following resection of an atrial myxoma, and review the clinical and imaging features of myxomatous aneurysms as reported in the literature. The most prominent imaging features of myxomatous aneurysms are their multiplicity, fusiform shape and distal location whereas from a clinical point of view they most often present with stroke like symptoms rather than with hemorrhage. These neurological manifestations may occur even after successful and complete surgical removal of the atrial myxoma.

Rupture of Cerebral Myxomatous Aneurysm Months After Resection of the Primary Cardiac Tumor

The natural history of cerebral aneurysms derived from metastatic spread of cardiac myxomas is not well known, and their management presents many dilemmas. Case report and literature review. An 18-year-old man presented with an intraparenchymal hemorrhage several months after resection of an atrial myxoma. Angiography showed several myxomatous aneurysms, one of which had bled. The patient had a recurrent hemorrhage before undergoing surgical resection. MRI, angiographic, and pathological data are presented for this rare condition. Myxomatous aneurysms are important entities for neurointensivists to recognize and can present years after diagnosis. Patients presenting with cerebral infarction or hemorrhage of unknown etiology should undergo cardiac imaging to rule out atrial myxoma, as up to 50% of patients with myxomas present initially with stroke.

Multiple Cerebral Aneurysms Associated with Atrial Myxoma

Cardiac myxoma is a tumor of mesenchymal origin accounting for half of all primary cardiac neoplasms. Intracranial involvement by atrial myxoma is a rare cause of neurologic deficit. When the myxoma arises in the left atrium, systemic emboli from a cardiac myxoma can lead to infarction, cerebral hemorrhage and aneurysm formation. In the light of the potentially preventable nature of these lesions, the diagnosis of myxomatous aneurysms should be considered in any patient with neurologic symptoms and a history of cardiac myxoma. Because aneurysms are often stable over several years, conservative management with careful clinical and radiological follow-up with MRI and angiography seems sensible. We describe a case in which MR imaging and angiography were used to diagnose multiple cerebral aneurysms caused by left atrial myxoma.

Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: a case report and review

Left cardiac myxoma and also consecutive embolization into the brain is well documented, whereas the association of myxomas with multiple fusiform cerebral aneurysms is rare. We analyze 33 previously reported patients and present a case of a 43-year-old woman with multiple cerebral infarctions 2 years after resection of a recurrent myxoma in the left atrium. Cerebral angiography displayed multiple fusiform aneurysms of several cerebral arteries, including a giant aneurysm of the basilar artery. Serum level of interleukin-6 (IL-6) was highly elevated. The clinical, radiological and pathological features of these aneurysms are summarized. The pathogenesis, including the role of IL-6 in the formation of myxomatous aneurysms, is discussed.