Chen Chao, Xu Yiya, Zhuang Wenjin, Zhao Zhenhua, Wang Yinzhou
Department of Neurology, Fujian Provincial Hospital, Fuzhou, CHN.
Shengli Clinical Medical College, Fujian Medical University, Fuzhou, CHN.
Cureus. 2021 Aug 23;13(8):e17402. doi: 10.7759/cureus.17402. eCollection 2021 Aug.
Subarachnoid hemorrhage (SAH) is a rare neurological complication of cardiac myxoma and is associated with poor outcomes. Previous reports have shown that myxoma-associated SAH was contributed by rupture of myxomatous intracerebral aneurysm. Here, we present an unusual case of angiographic-negative SAH in a young patient with left atrial myxoma. A 28-year-old male was admitted for SAH. He had a history of magnetic resonance imaging (MRI)-confirmed ischemic stroke one year ago. The digital subtraction angiography (DSA) performed on next day revealed no intracerebral aneurysm or vascular malformation. Transthoracic echocardiography (TTE) showed a left atrial mass measuring 5.09 * 3.34 cm, indicating a diagnosis of atrial myxoma, which was confirmed by pathological examination. The cardiac tumor was excised and the patient's symptoms improved completely. No intracerebral aneurysm was found by brain computed tomographic angiography (CTA) performed on day 24 after onset and one year after discharge. The patient remained asymptomatic during the one-year following-up. The result suggests that SAH may be more commonly associated with cardiac myxoma than previously expected. And, mechanisms other than rupture of myxomatous intracerebral aneurysm involve in SAH associated with cardiac myxoma. Prolonged length of following-up using novel imaging technique should be applied to identify and monitor the change of source bleeding.
蛛网膜下腔出血（SAH）是心脏黏液瘤罕见的神经系统并发症，且与不良预后相关。既往报道显示，黏液瘤相关的SAH是由黏液瘤性脑内动脉瘤破裂所致。在此，我们报告一例年轻的左心房黏液瘤患者发生血管造影阴性SAH的罕见病例。一名28岁男性因SAH入院。他一年前有磁共振成像（MRI）确诊的缺血性卒中病史。次日进行的数字减影血管造影（DSA）未发现脑内动脉瘤或血管畸形。经胸超声心动图（TTE）显示左心房有一大小为5.09×3.34 cm的肿块，提示心房黏液瘤诊断，病理检查证实了这一诊断。切除心脏肿瘤后，患者症状完全改善。发病后第24天及出院后一年进行的脑部计算机断层血管造影（CTA）未发现脑内动脉瘤。患者在随访的一年中一直无症状。结果表明，SAH可能比之前预期的更常与心脏黏液瘤相关。而且，除黏液瘤性脑内动脉瘤破裂外的其他机制也参与了与心脏黏液瘤相关的SAH。应采用新型成像技术进行更长时间的随访，以识别和监测出血源的变化。
