Lee Vivien H, Connolly Heidi M, Brown Robert D
Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Arch Neurol. 2007 Aug;64(8):1115-20. doi: 10.1001/archneur.64.8.1115.
Neurologic complications can be the initial manifestation of atrial myxoma. Prompt diagnosis is of paramount significance to prevent recurrent complications.
To identify patients with neurologic complications attributed to atrial myxoma.
DESIGN, SETTING, AND PATIENTS: With institutional review board approval, we retrospectively reviewed the medical records of 74 consecutive patients with pathologically confirmed cardiac myxoma at the Mayo Clinic from January 1, 1993, through December 31, 2004.
Discharge and follow-up modified Rankin score.
Nine of the 74 patients with cardiac myxoma (12%) presented with neurologic manifestations in the setting of atrial myxoma. Mean age was 48.5 years (range, 17-70 years). There were 6 females and 3 males. Among patients with myxoma and neurologic symptoms, ischemic cerebral infarct was the most common neurologic manifestation (8 patients [89%]). No patients had concomitant cardiac symptoms. The size of the atrial myxoma was variable, with a mean diameter of 2.7 (range, 0.4-6.5) cm. Most of the atrial myxomas causing neurologic symptoms demonstrated a mobile component on transesophageal echocardiography (8 patients [89%]). Two patients (22%) had pathologic evidence of systemic myxomatous emboli. One patient with intracerebral hemorrhage had pathologically confirmed intracranial metastatic myxoma and myxoma-induced aneurysmal dilatation.
Neurologic complications are associated with cardiac myxoma in some patients with myxoma and, when they occur, frequently present with cerebral infarction. The mobility, not the size, of the myxoma appears to be related to embolic potential. Potential delayed neurologic complications relevant to patients with tumor embolization include myxoma-induced cerebral aneurysm and myxomatous metastasis, which can mimic the clinical picture of central nervous system vasculitis or infective endocarditis.
神经系统并发症可能是心房黏液瘤的首发表现。及时诊断对于预防复发性并发症至关重要。
识别患有由心房黏液瘤引起的神经系统并发症的患者。
设计、场所和患者：经机构审查委员会批准，我们回顾性分析了1993年1月1日至2004年12月31日在梅奥诊所连续74例经病理证实为心脏黏液瘤患者的病历。
出院时及随访时的改良Rankin评分。
74例心脏黏液瘤患者中有9例（12%）在心房黏液瘤背景下出现神经系统表现。平均年龄为48.5岁（范围17 - 70岁）。女性6例，男性3例。在患有黏液瘤和神经系统症状的患者中，缺血性脑梗死是最常见的神经系统表现（8例[89%]）。无患者伴有心脏症状。心房黏液瘤大小不一，平均直径为2.7（范围0.4 - 6.5）cm。大多数引起神经系统症状的心房黏液瘤在经食管超声心动图检查时显示有可移动成分（8例[89%]）。2例患者（22%）有系统性黏液瘤栓子的病理证据。1例脑出血患者经病理证实有颅内转移性黏液瘤及黏液瘤诱发的动脉瘤样扩张。
在一些黏液瘤患者中，神经系统并发症与心脏黏液瘤相关，且一旦发生，常表现为脑梗死。黏液瘤的可移动性而非大小似乎与栓塞潜能有关。与肿瘤栓塞患者相关的潜在延迟性神经系统并发症包括黏液瘤诱发的脑动脉瘤和黏液瘤转移，这可能会模仿中枢神经系统血管炎或感染性心内膜炎的临床表现。
