Stroke Unit, Neurology Department, Biomedical Research Institute Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
Stroke Unit, Neurology Department, Biomedical Research Institute Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
J Stroke Cerebrovasc Dis. 2015 Apr;24(4):e87-9. doi: 10.1016/j.jstrokecerebrovasdis.2014.10.020. Epub 2015 Feb 11.
We report a case of stroke due to stenosis caused by a myxoma in the common carotid artery with no evidence of a cardiac origin. Only 1 such case has been reported previously in the literature.
A previously healthy 37-year-old woman presented with repeated episodes of acute focal deficits together with motor, sensory, and language symptoms typical of left internal carotid territory involvement. Brain magnetic resonance imaging showed acute and subacute ischemic lesions in the territory of the left middle cerebral artery and border zone infarcts (middle cerebral artery with anterior and posterior cerebral arteries). Magnetic resonance angiography showed a filling defect in the distal portion of the left common carotid artery causing stenosis over 70%. Transesophageal echocardiography showed no embolic sources. Blood tests ruled out a prothrombotic state.
The image was initially interpreted as a possible subacute thrombus and anticoagulation was started. No changes were observed in the follow-up carotid ultrasound examination after 12 days of treatment. A gelatinous mass was removed during carotid surgery. No subjacent lesion was observed in the vessel wall. Pathology examination showed a spindle cell fibromyxoid tissue with fibrinoid material typical of myxoma.
We hypothesize that the myxoma originated in the vessel, or alternatively, that a cardiac myxoma embolized without leaving a residual cardiac tumor. Although exceptional, myxoma should be added to the list of unusual causes of carotid artery stenosis causing stroke.
我们报告了一例因颈总动脉黏液瘤引起狭窄导致的中风病例，且该病例无心脏起源的证据。文献中此前仅报道过 1 例此类病例。
一名既往健康的 37 岁女性出现反复急性局灶性缺损，伴有典型的左侧颈内动脉区域受累的运动、感觉和语言症状。脑磁共振成像显示左侧大脑中动脉和交界区梗死（大脑中动脉伴前循环和后循环）的急性和亚急性缺血性病变。磁共振血管造影显示左颈总动脉远端有充盈缺损，导致狭窄超过 70%。经食管超声心动图未显示栓塞源。血液检查排除了血栓前状态。
最初的图像被解释为可能是亚急性血栓，开始进行抗凝治疗。治疗 12 天后，颈动脉超声检查未见变化。在颈动脉手术后取出了一个胶状肿块。血管壁无下伏病变。病理检查显示梭形细胞纤维粘液样组织，伴有纤维蛋白样物质，符合黏液瘤特征。
我们假设黏液瘤起源于血管，或者是心脏黏液瘤在没有留下残留心脏肿瘤的情况下发生了栓塞。尽管罕见，但黏液瘤应被添加到导致中风的颈动脉狭窄的不常见病因列表中。
