Case of the Month
Section Editor: Nicholas Stence, MD
Children's Hospital Colorado, Aurora, CO
July 2013
Next Case of the Month coming August 6 . . .
Cardiac Myxoma Metastasis
- Myxoma is a rare benign primary cardiac tumor.
- Systemic embolism of myxoma fragments has been described in literature; its incidence is 45%, with involvement of the brain in half of these cases.
- Metastatic brain lesions sometimes present earlier than the primary lesion, as in the case presented. These lesions are usually multiple and most commonly located at the gray-white matter junction.
- Clinical Presentation: Headache, vertigo, focal seizures, and hemiparesis
- Key Diagnostic Features: Intraparenchymal appearing hemorrhagic lesions of various sizes with minimal surrounding edema. Occasionally, strokes.
- DDx: Hypertensive vascular disease, cerebral amyloid angiopathy , arteriovenous malformation, multiple cavernous malformations, primary neoplasm (glioblastoma with hemorrhage) , metastatic tumors (eg, melanoma, anaplastic lung carcinoma, thyroid carcinoma, choriocarcinoma), hemorrhagic arterial/venous strokes, trauma
- Rx: Surgical removal of left atrium myxoma and radiotherapy for brain metastasis
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