Yeh Huai-Hua, Yang Chi-Chiang, Tung Wai-Fai, Wang Hsin-Fan, Tung Jai-Nien
Section of Neurology, Tungs' Taichung Metroharbor Hospital, Taiwan.
Acta Neurol Taiwan. 2006 Sep;15(3):201-5.
Cardiac myxoma is a source of emboli to the vascular tree, especially to the central nervous system. Although it is rare, its early recognition is particularly important because of its unique clinical features of subsequently leading to intracerebral or subarachnoid hemorrhage, even brain metastases, and its potential for surgical cure. Missing the diagnosis may lead to devastating results, including stroke, even sudden death. A 40-year-old male with no other conventional vascular risk factors such as hypertension, diabetes or hyperlipidemia presented with right hemiplegia, global aphasia, vomiting, and fever. Infarction over the left middle cerebral artery was disclosed on magnetic resonance imaging study, and echocardiogram showed a huge mass, about 5cm in size, on the mitral valve which was histopathologically proved to be a cardiac myxoma. He also presented with multiple emboli to the kidneys and the left eye. There is uncertainty about the role of anticoagulation. The treatment of choice remains surgical excision of the cardiac myxoma which may lead to normalization of serum interleukin-6 levels and resolution of constitutional symptoms, and the intracranial aneurysms may regress and resolve.
心脏黏液瘤是血管系统，尤其是中枢神经系统栓子的来源。尽管它很罕见，但因其具有随后导致脑内或蛛网膜下腔出血甚至脑转移的独特临床特征以及手术治愈的可能性，早期识别尤为重要。漏诊可能导致毁灭性后果，包括中风甚至猝死。一名40岁男性，无高血压、糖尿病或高脂血症等其他传统血管危险因素，出现右侧偏瘫、完全性失语、呕吐和发热。磁共振成像检查显示左侧大脑中动脉供血区梗死，超声心动图显示二尖瓣上有一个巨大肿块，大小约5厘米，组织病理学证实为心脏黏液瘤。他还出现了肾脏和左眼的多处栓塞。抗凝的作用尚不确定。治疗的首选仍然是手术切除心脏黏液瘤，这可能会使血清白细胞介素-6水平恢复正常并缓解全身症状，颅内动脉瘤可能会消退和消失。
