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Cardiac Myxoma Causing Acute Ischemic Stroke in a Pediatric Patient and a Review of Literature

  • Jennifer Fuchs
    Correspondence
    Communications should be addressed to: Dr. Fuchs; 1520 Split Oak Lane; Apt. D; Henrico, VA 23229.
    Affiliations
    Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia
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  • David Leszczyszyn
    Affiliations
    Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia

    Department of Neurology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia
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  • Don Mathew
    Affiliations
    Department of Pediatrics, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia

    Department of Neurology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia
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      Abstract

      Background

      Ischemic stroke in the pediatric population is a rare occurrence, and its possible causes span a wide differential that includes atrial myxomas. Myxomas are friable cardiac tumors that produce “showers” of emboli resulting in transient neurological deficits, cutaneous eruptions, and ophthalmologic deficits.

      Patient

      We present an 11-year-old boy with a months-long history of an intermittent spotted “rash” who presented with acute ischemic stroke caused by a left atrial myxoma. We also review clinical features in all 16 other cases of cardiac myxoma causing pediatric stroke reported in the literature.

      Results

      Our case, along with the review of the literature, highlights the fact that myxomas often initially present as stroke with acute hemiplegia and transient cutaneous eruptions due to fragmentation of the tumor.

      Conclusions

      Cardiac myxoma should be considered in any child presenting with ischemic stroke, and transient skin findings may provide an important diagnostic clue prior to onset of neurological symptoms.

      Keywords

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      References

        • Roach S.
        • Golomb M.
        • Adams R.
        • et al.
        Management of Stroke in Infants and Children: a Scientific Statement from a Special Writing Group of the American Heart Association Stroke Council and the Council on Cardiovascular Disease in the Young.
        Stroke. 2008; 39: 2644-2691
        • Yang J.
        • Park Y.
        • Hartlage P.
        Seizures associated with stroke in childhood.
        Pediatr Neurol. 1995; 12: 136-138
        • Al-Mateen M.
        • Hood M.
        • Trippel D.
        • Samuel J.I.
        • Otto R.K.
        • Vitikainen K.J.
        Cerebral embolism from atrial myxoma in pediatric patients.
        Pediatrics. 2003; 112: e162-e167
        • Bayir H.
        • Morelli P.J.
        • Smith T.H.
        • Biancaniello T.A.
        A left atrial myxoma presenting as a cerebrovascular accident.
        Pediatr Neurol. 1999; 21: 569-572
        • Knepper L.E.
        • Biller J.
        • Adams Jr., H.P.
        • Bruno A.
        Neurologic manifestations of atrial myxoma: a 12 year experience and review.
        Stroke. 1988; 19: 1435-1440
        • Padalino M.
        • Basso C.
        • Svaluto Moreolo G.
        • et al.
        Left atrial myxoma in a child: case report and review of the literature.
        Cardiovasc Pathol. 2003; 12: 233-236
        • Mahar L.J.
        • Lie J.T.
        • Groover R.V.
        • et al.
        Primary cardiac myxosarcoma in a child.
        Mayo Clin Proc. 1979; 54: 261-266
        • Ghosh A.
        • Bhattacharyya A.
        • Niyogi P.
        Recurrent left atrial myxoma with recurrent stroke.
        Indian Pediatr. 2001; 38: 1190-1192
        • Tipton B.K.
        • Robertson J.T.
        • Robertson J.H.
        Embolism to the central nervous system from cardiac myxoma: report of two cases.
        J Neurol. 1977; 47: 927-940
        • Bobo H.
        • Evans O.B.
        Intracranial aneurysms in a child with recurrent atrial myxoma.
        Pediatr Neurol. 1987; 3: 230-232
        • Tonz M.
        • Laske A.
        • Carrel T.
        • et al.
        Convulsions, hemiparesis and central retinal artery occlusion due to left atrial myxoma in a child.
        Eur J Pediatr. 1992; 151: 652-654
        • Hung P.C.
        • Wang H.S.
        • Chou M.L.
        • et al.
        Multiple cerebral aneurysms in a child with cardiac myxoma.
        J Formos Med Assoc. 1992; 91: 818-821
        • Goldberg H.P.
        • Glenn F.
        • Dotter C.T.
        • et al.
        Myxoma of the left atrium: diagnosis made during life with operative and post-mortem findings.
        Circulation. 1952; 6: 762-767
        • Landes C.
        • Baumann R.
        • Coffrill C.M.
        Embolic strokes in an 8-year-old girl.
        Neurology. 2000; 55: 146
        • Sernich S.
        • Chauhan A.
        • Singh D.
        • Fuchs H.
        • Caspi J.
        Left atrial myxoma in a child: a challenging diagnosis of a rare lesion.
        World J Pediatr Congenit Heart Surg. 2013; 4: 220-222
        • Ruiz Pérez L.
        • Sempere Pérez A.
        • García Alonso A.
        • Alenda González C.
        • Flores Serrano J.
        Cerebrovascular stroke as a sign of atrial myxoma in childhood [in Spanish].
        An Pediatr (Barc). 2003; 58: 273-276
        • Briassoulis G.
        • Kuburovic V.
        • Xekouki P.
        • et al.
        Recurrent left atrial myxomas in carney complex: a genetic cause of multiple strokes that can be prevented.
        J Stroke Cerebrovasc Dis. 2012; 21: 914.e1-914.e8
        • Pridie R.
        Left atrial myxomas in childhood: presentation with emboli – diagnosis by ultrasonics.
        Thorax. 1972; 27: 759-763
        • Beanlands D.
        • Dolan D.
        • Shane S.
        Myxoma of the left atrium – case report.
        CMAJ. 1960; 83: 715-717
        • Reynen K.
        Cardiac myxomas.
        N Engl J Med. 1995; 333: 1610-1617
        • Sedat J.
        • Chau A.
        • Dunac N.
        • et al.
        Multiple cerebral aneurysms caused by cardiac myxoma.
        Interv Neuroradiol. 2007; 13: 179-184