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Multiple intracranial aneurysms years after cardiac myxoma resection
  1. Roberto Mendes Franco1,2,
  2. José Sousa3,4,
  3. Mariana Matos5,6,
  4. Luís Albuquerque3,4,
  5. Elsa Azevedo1,4,
  6. Pedro Abreu1,4
  1. 1 Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal
  2. 2 Department of Neurology, Hospital Dr. Nélio Mendonça, Funchal, Portugal
  3. 3 Neuroradiology, Centro Hospitalar Universitário de São João, Porto, Portugal
  4. 4 Department of Clinical Neurosciences and Mental Health, Faculty of Medicine of University of Porto, Porto, Portugal
  5. 5 Department of Internal Medicine, Centro Hospitalar Universitário de São João, Porto, Portugal
  6. 6 Department of Internal Medicine, Faculty of Medicine of University of Porto, Porto, Portugal
  1. Correspondence to Dr Roberto Mendes Franco, Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; robertolfranco{at}gmail.com

https://doi.org/10.1136/pn-2023-003705

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    Embolic ischaemic strokes are the most common neurological manifestation of cardiac myxomas, though accounting for only 0.5% of all ischaemic strokes.1 A 47-year-old woman developed an ischaemic stroke of the distal branch of the left middle cerebral artery (figure 1) but was not a candidate for reperfusion treatment. Investigations excluded the common causes of stroke but identified a left atrial myxoma, which was promptly removed. A CT cerebral angiogram was unremarkable, with no discernible intracranial aneurysms. However, 8 years later, when she presented with non-specific complaints, a further CT cerebral angiogram (and MR and digital subtraction angiograms) showed bilateral multifocal fusiform/dysplastic intracranial aneurysms, including at the site of the previous middle cerebral artery occlusion (figures 1 and 2). Further thorough investigation excluded common genetic causes, connective tissue-related disorders and infective/inflammatory conditions, suggesting that the multiple intracranial aneurysms most likely related to the previous myxomatous embolisation.

    Figure 1

    Initial CT cerebral …

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    Footnotes

    • Contributors RMF: design, concept and draft of the manuscript. JMMS: provided significant input for early and final drafts of the manucript. MM: provided significant input for early and final drafts of the manucript. LA: provided significant input for early and final drafts of the manucript. EA: manuscript design, supervision and critical revision of manucript. PA: manuscript design, supervision and critical revision of manucript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed by David Werring, London, UK.