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Vivien H. Lee, MD; Heidi M. Connolly, MD; Robert D. Brown Jr, MD

Arch Neurol. 2007;64(8):1115-1120.

Background  Neurologic complications can be the initial manifestation of atrial myxoma. Prompt diagnosis is of paramount significance to prevent recurrent complications.

Objective  To identify patients with neurologic complications attributed to atrial myxoma.

Design, Setting, and Patients  With institutional review board approval, we retrospectively reviewed the medical records of 74 consecutive patients with pathologically confirmed cardiac myxoma at the Mayo Clinic from January 1, 1993, through December 31, 2004.

Main Outcome Measures  Discharge and follow-up modified Rankin score.

Results  Nine of the 74 patients with cardiac myxoma (12%) presented with neurologic manifestations in the setting of atrial myxoma. Mean age was 48.5 years (range, 17-70 years). There were 6 females and 3 males. Among patients with myxoma and neurologic symptoms, ischemic cerebral infarct was the most common neurologic manifestation (8 patients [89%]). No patients had concomitant cardiac symptoms. The size of the atrial myxoma was variable, with a mean diameter of 2.7 (range, 0.4-6.5) cm. Most of the atrial myxomas causing neurologic symptoms demonstrated a mobile component on transesophageal echocardiography (8 patients [89%]). Two patients (22%) had pathologic evidence of systemic myxomatous emboli. One patient with intracerebral hemorrhage had pathologically confirmed intracranial metastatic myxoma and myxoma-induced aneurysmal dilatation.

Conclusions  Neurologic complications are associated with cardiac myxoma in some patients with myxoma and, when they occur, frequently present with cerebral infarction. The mobility, not the size, of the myxoma appears to be related to embolic potential. Potential delayed neurologic complications relevant to patients with tumor embolization include myxoma-induced cerebral aneurysm and myxomatous metastasis, which can mimic the clinical picture of central nervous system vasculitis or infective endocarditis.

Author Affiliations: Department of Neurology (Drs Lee and Brown) and Division of Cardiovascular Diseases (Dr Connolly), Mayo Clinic College of Medicine, Rochester, Minnesota. Dr Lee is now with the Department of Neurologic Sciences, Rush University Medical Center, Chicago, Illinois.

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