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Biatrial myxoma and cerebral ischemia successfully treated with intravenous thrombolytic therapy and surgical resection.

ABSTRACT: We report what we believe is the 1st case in the medical literature in which an intravenous thrombolytic agent was used successfully--without massive intracranial bleeding--to treat acute stroke induced by atrial myxoma. Our patient, who had biatrial myxomas with a dual blood supply from the right coronary artery, presented with cerebral ischemia. Transesophageal echocardiography was essential in clarifying the diagnosis and in helping to direct surgical treatment.

SUBMITTER: Ibrahim M

PROVIDER: S-EPMC2435448 | biostudies-literature | 2008

REPOSITORIES: biostudies-literature

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Biatrial myxoma and cerebral ischemia successfully treated with intravenous thrombolytic therapy and surgical resection.

Ibrahim Morhaf M Iliescu Cezar C Safi Hazim J HJ Buja Maximilian L ML McPherson David D DD Fuentes Francisco F

Texas Heart Institute journal 20080101 2

We report what we believe is the 1st case in the medical literature in which an intravenous thrombolytic agent was used successfully--without massive intracranial bleeding--to treat acute stroke induced by atrial myxoma. Our patient, who had biatrial myxomas with a dual blood supply from the right coronary artery, presented with cerebral ischemia. Transesophageal echocardiography was essential in clarifying the diagnosis and in helping to direct surgical treatment. ...[more]

PMID: 18612442

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Cerebral embolism associated with left atrial myxoma that was treated with thrombolytic therapy.

Project description:We present a case of cerebral embolism associated with a left atrial myxoma that was treated with intravenous thrombolytic therapy. A 79-year-old right-handed man with no history of neurological or psychiatric illnesses was referred to our hospital because of confusion. He had been self-supported in the activity of daily living and could enjoy gardening until just before his admission. He had aphasia, left conjugate deviation, right hemiparesis, and right pathological reflexes. His NIHSS score was 24. Cranial DWI showed hyperintense lesions in the left middle cerebral artery territory, and MRA revealed left middle cerebral artery occlusion. We started treatment with the recombinant tissue plasminogen activator alteplase intravenously 3 h after the onset. However, the therapy was ineffective, and the NIHSS score was 25 on the second day. A transthoracic echocardiogram and heart MRI showed a left atrial myxoma. However, surgery was contraindicated because of the patient's poor general condition. Although intravenous recombinant tissue plasminogen activator is a reasonable treatment for stroke patients, even with a cardiac myxoma, we cannot always expect good effects, especially if the emboli are parts of the tumor itself. In this case, we could not perform an endovascular mechanical embolectomy; however, we speculate that mechanical embolus retrieval in cerebral ischemia might be effective in such cases.

| S-EPMC3335447 | biostudies-literature

A Biatrial Myxoma with Triple Ripples.

Project description:Cardiac myxoma is a benign tumor, but it is known for its space-occupying effect at the site of origin and frequent systemic embolization. This case report highlights a biatrial myxoma of interatrial septum who presented with significant tricuspid valve regurgitation, atrial fibrillation, and cardioembolic stroke of the left parietal lobe, i.e., a biatrial myxoma with triple ripples.

| S-EPMC5875139 | biostudies-literature

Elusive for Years: Rare Biatrial Myxoma.

Project description: Not available

| S-EPMC10403632 | biostudies-literature

A butterfly shaped mobile biatrial cardiac mass: myxoma or something else.

Project description:Primary cardiac tumors are rare with a reported prevalence of 0.01-0.02% based on pooled autopsy series. Although most mobile cardiac tumors arising from the interatrial septum and extending into the atria are thought to be benign myxomas, this may often not be true. Myxoid fibrosarcomas which in contrast to myxomas are malignant cardiac tumors often mimic the clinical and echocardiographic picture of atrial myxomas. We describe a rare entity of biatrial low-grade myxoid fibrosarcoma presenting in an adult patient as a butterfly shaped mass, with progressive shortness of breath and prolonged PR interval on the ECG that was pre-operatively thought to be a cardiac myxoma. The distinguishing echocardiographic features of the two entities are discussed.

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Impact of Interatrial Septal Reconstruction on Atrial Tachyarrhythmia after Surgical Resection of Myxoma.

Project description:BackgroundComplete surgical excision is the only curative treatment for primary cardiac tumors. For wide excision, interatrial septal reconstruction (ISR) is commonly performed. We hypothesized that ISR may increase the risk of postoperative atrial tachyarrhythmia (AT) after surgical resection of cardiac myxoma.MethodsAfter excluding patients with a history of cardiac surgery and concomitant procedures unrelated to tumor resection and those with AT or permanent pacemakers, we finally enrolled 272 adult patients who underwent benign cardiac tumor surgery from 1995 to 2021 at our institution. They were divided into the ISR (n=184) and non-ISR (n=88) groups. The primary outcome was postoperative new-onset AT.ResultsThe study cohort predominantly consisted of women (66.2%), with a mean age of 57.2±13.6 years. The incidence of postoperative new-onset AT was 15.4%. No 30-day mortality or recurrence was observed. The cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the ISR group than in the non-ISR group (p<0.001). The median duration of hospital stay of all patients was 6.0 days (interquartile range, 5.0-7.0 days), and no significant difference was observed between the 2 groups (p=0.329). ISR was not an independent predictor of new-onset AT (p=0.248). Male sex and hypertension were found to be independent predictors of new-onset AT.ConclusionISR was not a significant predictor of postoperative new-onset AT. ISR might be a feasible and safe procedure for surgical resection of cardiac myxoma and should be considered if needed.

| S-EPMC10165435 | biostudies-literature

Mesenchymal stem cell-loaded hydrogel improves surgical treatment for chronic cerebral ischemia

Project description:Chronic cerebral ischemia (CCI) results in a prolonged insufficient blood supply to the brain tissue, leading to impaired neuronal function and subsequent impairment of cognitive and motor abilities. Our previous research showed that in mice with bilateral carotid artery stenosis, the collateral neovascularization post Encephalo-myo-synangiosis (EMS) treatment could be facilitated by bone marrow mesenchymal stem cells (MSCs) transplantation. Considering the advantages of biomaterials, we synthesized and modified a gelatin hydrogel for MSCs encapsulation. We then applied this hydrogel on the brain surface during EMS operation in rats with CCI, and evaluated its impact on cognitive performance and collateral circulation.

2024-06-10 | GSE269005 | GEO

Cerebral Salt Wasting Syndrome (CSW): An unusual cause of hypovolemia after spontaneous cerebral hemorrhage successfully treated with fludrocortisone

Project description:Objective Our objective is to demonstrate the interest of thinking about Cerebral salt wasting syndrome (CSW) in front of hyponatremia with severe hypovolemia after a brain injury, and at the same time the interest to differentiate between Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) and Cerebral salt wasting syndrome (CSW) as two etiologies to be evoked in front of a hyponatremia with brain injury. Case report: We report the case of a 63-year-old patient with a recent history of hemorrhagic stroke admitted for severe hypovolemic shock in whom the investigations find a very deep hypotonic hyponatremia secondary to a cerebral salt wasting syndrome successfully treated with fludrocortisone. Discussion: CWS is characterized by hypotonic hyponatremia associated with cerebral associated with hypovolemia, the difficulty of the diagnosis is explained by the points of convergences with SIADH which is also presented with hyponatremia. The treatment is based on filling with saline, if the symptoms are severe, hypertonic saline has its place. Fludrocortisone has proven its effectiveness in the correction of refractory hyponatremia in CWS. Conclusion: It is essential to differentiate between hyponatremia in CWS and hyponatremia in SIADH because the medical care is categorically different.

| S-EPMC8577092 | biostudies-literature

Case Report: Congenital Intracranial Kaposiform Hemangioendothelioma Treated With Surgical Resection.

Project description:BackgroundKaposiform hemangioendothelioma (KHE) is a locally aggressive but non-metastatic vascular neoplasm. Most studies have been restricted to small case series of limited generalizability. Intracranial KHE is extremely rare with only three cases reported in the literature. Here, we report a case of congenital intracranial KHE who underwent surgical resection, and no lesion recurrence was seen during the follow-up period of 13 months.Case descriptionA 2-month-old boy initially presented with a left temporal mass following birth. Antenatal ultrasound at 36 weeks of gestation demonstrated a hyperechoic signal present in the left frontal lobe, with clear borders and irregular morphology. There were neither cutaneous abnormalities nor other neurologic examination abnormalities. No laboratory abnormality was identified. Computed tomography (CT) scans suggested that a massive hematoma was noted under the left frontal skull plate, with a little subdural hemorrhage in the adjacent temporal area. The adjacent meninges enhanced and thickened on contrasted T1 magnetic resonance (MR). After the multidisciplinary diagnostic assessment, the surgery was performed by the left frontotemporal craniotomy approach. The operation was extremely difficult. We completely removed the tumor, and the involved dura and brain tissue were resected with the lesion in a piecemeal fashion. On postoperative-day (POD) 3 and POD 14, the head CT re-examination revealed that cerebral perfusion improved gradually. The MRI of 6- and 12-month after operation showed no local recurrence or metastasis.ConclusionsIntracranial KHE is difficult to diagnose early and the prognosis has been uniformly poor. We supposed that meticulous intraoperative hemostasis is the key for a successful operation, and the radical resection of the tumor and involved structures are essential to reduce recurrence.

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A case of duodenal polyp at superior duodenal angle successfully treated by cap-assisted endoscopic mucosal resection.

Project description: Not available

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Eclipsed mitral regurgitation successfully treated with a combination of surgical and pharmacological therapies: a case report.

Project description:Eclipsed mitral regurgitation (MR), which is characterized by a transient and reversible massive functional MR, usually causes recurrent episodes of acute pulmonary oedema in patients with a preserved left ventricular ejection fraction. The pathophysiological mechanism and optimal treatment of eclipsed MR are not yet fully understood. A 72-year-old woman was hospitalized with cardiogenic shock and takotsubo cardiomyopathy. After hospitalization worsening dyspnoea again appeared, and urgent transthoracic echocardiography revealed severe MR, which spontaneously resolved in a few minutes. At this point, eclipsed MR was detected for the first time. Diagnostic examination revealed that the eclipsed MR was caused by a left ventricular afterload increase. Ultimately, the patient began medical therapy and underwent mitral valve replacement. The subsequent clinical course was favourable. This case illustrates the importance of early intervention for eclipsed MR. A combination of surgical and pharmacological therapies can serve as one treatment option for an eclipsed MR.

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