A Silent Tumor with Devastating Consequences: Atrial Myxoma and Stroke in a Pediatric Patient Case Report
Pedro Gil Landeros1, Aurelio Méndez Domínguez1, Beatriz Adriana Olivera Pérez1
1Deparment of Neurology, National Institute of Cardiology "Ignacio Chávez"
Objective:
To report a rare case of atrial myxoma in a pediatric patient whose first manifestation was a devastating ischemic stroke.
Background:
Stroke can occur at any age; however, it shows a higher incidence during adulthood, most of the time in the pediatric population the expression is atypical and unusual. Among the causes of stroke in children, cardioembolic mechanisms are rare, atrial myxoma representing an exceptional (<0.28%). The present case illustrates a devastating ischemic stroke as an initial manifestation of a cardiac neoplasm in a pediatric patient.
Design/Methods:
A 13-year-old female admitted to the emergency department with a 12-hour history of focal neurological deficit (left hemiparesis), NIHSS 16. Brain magnetic resonance imaging (MRI) revealed an extensive right hemispheric subacute ischemic stroke involving the M1–M2 segments of RMCA. The extensive etiological workup showed an intracardiac mass in the left atrium measuring 78×42 mm, consistent with an atrial myxoma. The patient underwent cardiac surgery with resection of the left atrial tumor, without systemic or neurological complications. The additional workup did not exhibit any additional abnormalities. After 30 days of follow-up, she showed improvement in left hemiparesis (NIHSS 7 points), and a follow-up brain MRI revealed no new ischemic lesions after surgery.
Results:
Cardiac myxoma is accepted as an uncommon cause of stroke in the pediatric population. We emphasized the importance of the typical triad (cardiac obstructive symptoms, constitutional manifestations and embolic phenomena) that can appear in >30% of cases. The incidence is 2 per 100,000 children per year, and the stroke presentation is rare as a first presentation. Previous reports elucidate the prognosis is generally favorable specially when the early diagnosis and surgical resection are performed.
Conclusions:
The current medical literature is remarkable in demonstrating limited information about myxoma incidence in the pediatric population. Also the importance in establishing a collaborative interaction between Paediatricians, Cardiologists and Neurologists.
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