Cardiac phoenix in the brain-occult intracranial hemorrhagic metastases from completely resected atrial myxoma.

BACKGROUND

Cardiac myxomas are sporadic in nature and can often recur with a frequency of 3%, especially in middle-aged women, and 22% of the cases account to a part of Carney complex. Complete surgical removal of the myxoma is usually curative. Recurrence has been related with partial surgical excision, multicentricity, and embolism of tumor fragments.

CASE DESCRIPTION

We report a case of a patient with single brain metastases due to tumor embolization, from a cardiac myxoma operated prior. This case is exclusive, as tumor embolization from atrial myxoma to the cerebral cortex can be possible, within a short duration. In our case, the patient was evaluated with a magnetic resonance imaging brain and a solitary hemorrhagic lesion in the eloquent cerebral cortex was observed. To determine the primary etiology, the diagnosis of probable metastases was thought of, and a thorough workup was planned. Surprisingly, no primary lesion was detected, and as a histological diagnosis was required, he underwent a navigation-guided excisional biopsy of lesion. The biopsy was indicative of a metastatic deposit from an atrial myxoma.

CONCLUSION

In eloquent cortex lesions, gross total resection is challenging for a neurosurgeon especially when the patient has no significant neurological deficits. Timely gross total resection of a solitary metastatic lesion can improve the patient's outcome and can enhance early recovery with less or no morbidity.