Neurological complications of left atrial myxoma: a case report on stroke with left atrial myxoma and postoperative brain metastasis and cerebral aneurysm

Abstract

Atrial myxoma is a rare benign tumor that can cause a variety of complications, including cerebral infarction. We present a case of a 52-year-old female patient who developed cerebral infarction caused by an atrial myxoma. The patient underwent successful surgical resection of the tumor, and the infarction was managed accordingly. However, 15-months post-surgery, the patient developed new neurological symptoms. Imaging studies revealed multiple cerebral metastases, consistent with the possibility of seeding of tumor cells. This rare complication emphasizes the importance of long-term monitoring after the resection of atrial myxomas. The occurrence of metastasis in the brain, though rare, should be considered in follow-up care, particularly in patients who have had embolic events related to atrial myxomas. Our case highlights the potential for cerebral myxoma metastasis even after initial successful surgical intervention, underscoring the need for comprehensive follow-up and vigilant monitoring of such patients.

Keywords: aneurysm; brain metastasis; ischemic stroke; left atrial myxoma; radiological imaging; tumor resection.

Figure 1

(A) Echocardiogram shows a 2.3 × 1.3 cm hyperechoic mass in the left atrium, attached to the interatrial septum. (B, C) MRI images reveal an irregular mass in the left atrium (~3.9 × 2.6 cm) with iso-intense signal on T1-weighted and hyperintense signal on T2-weighted images, attached to the interatrial septum with visible mobility.

Figure 2

(A, B) Non-enhanced CT (NECT) indicates ischemic infarction in the deep region of the left temporal lobe. (C, D) CT angiography (CTA) shows localized stenosis in the M2 segment of the left middle cerebral artery. (E–H) T2-weighted imaging (T2WI) and T2 FLAIR demonstrate patchy hyperintense signals in the bilateral frontal lobes, left basal ganglia, thalamus, parietal-temporal lobes, and hippocampus.

Figure 3

(A, B) Histopathological image of cardiac myxoma (H&E stain, 40 ×, 100×). The image shows cardiac myxoma tissue with round or polygonal tumor cells surrounded by abundant mucinous stroma under hematoxylin and eosin staining at 40×, 100× magnification.

Figure 4

(A–D) MRI with contrast enhancement: follow-up examination 15 months post-surgery. Nodular enhancements were observed in the bilateral frontal lobes, right parietal lobe, and left occipital lobe, with the largest lesion measuring 25 × 20 mm in the left occipital lobe. Additionally, non-enhancing areas were noted in the left corona radiata and basal ganglia.

Figure 5

Follow-up examination 23 months post-surgery. [(A, B); CT] Hyperdense masses with hemorrhagic components observed in the left temporal and occipital lobes. [(C–F); MRI] Abnormal signals in the left basal ganglia and occipital lobe on T1- and T2-weighted imaging, with partial diffusion restriction in the left temporo-occipital lobe on DWI/ADC. [(G, H); T1WI + C] Multiple enhancing nodules observed, with aneurysmal dilation in the M1 and M2 segments of the left middle cerebral artery.

Figure 6

The timeline of the case.