Multiple cerebral aneurysms originating from previously resected cardiac. Rev. Ang. de Ciênc. da Saúde. 2021 Jul – Dez; 2 (2): 10-13
At this time with almost 3 years of follow up the patient is asymptomatic (cardiologic and neurologic),scheduled for new angiography follow up in a year.
DISCUSSION Acute neurological complications of cardiac myxomas as stroke or aneurysm formation are well described butdelayed complications particularly fusiform aneurysms are very limited.The present case has both common and uncommon characteristics compared with previously described. Femalepatients are 71% of previously described, CM is in the left atrium in 91% and almost all aneurysms were fusiform(91%) these characteristics are compatible with our case8. On the other hand we present a case with some newsaspects in clinical presentation, that may help the medical community to perform diagnosis.The formation of aneurysms after the resection of cardiac myxoma is unclear. The tumor cells in the embolism leadto perivascular damage, the inflammatory response at the site of injury and the deposition of the tumor into thevasa vasorum were proposed hypotheses to explain the mechanism why there is progression of aneurysms despitethe surgery.The endocrine and secretory properties of CM cells support the tumor emboli deposition in the vessel wall. A23- year-old patient who presented with multiple cerebellar hemorrhages presented high levels of IL-6 in the CSF.These IL-6 levels returned to normal after resection of the CM and they have thus suggested these interleukines asa marker for neurological manifestations.Dyspnoea as initial isolated symptom of CM without constitutional symptoms was not previously described andthis can be a differential diagnosis of progressive dyspnea that can confirmed or ruled out by a inexpensive, noninvasive and fast exam – Echocardiogram 9 , that can show a pedunculated lesion occupying all left atrium asprevious biopsy shows 10 . The neurological symptom of this case (seizure) is also a new feature, previously describedneurological symptoms migraine like headache, motor strength deficits and conscious level alteration 7 .Treatments of cerebral aneurysm secondary to CM are not well defined. The conservative management is thepreferred choice. However, the finding that dividing tumor cells are responsible for aneurysm formation suggeststhe possibility of using chemotherapy to prevent aneurysmal growth, but the results of doxorubicin alone areequivocal 10 . Low-dose radiation therapy alone or in conjunction with chemotherapy revealed more encouragingresults 12,13 . Cardiac surgery to remove the primary cardiac tumors usually eliminates early neurologic symptoms,but cannot completely abolish the risk of delayed cerebral aneurysm formation, presumably as a result ofmetastatic seeding prior to surgery 11 . There are no randomized controlled trials to address this issue.We present a case that only two years later the patient presents multiple episodes of tonic – clonic seizureafter the CM resection. Recurrent embolic strokes with later evaluation revealed multiple cerebral aneurysmssecondary to a cardiac myxoma detected 10 and 25 years, respectively, as reported in the literature. Despitetreatment of cardiac myxoma, intracranial complications can have delayed presentation. Our case is in keepingwith the current literature of the preferential distribution to the MCA territory as compared to the vertebrobasilarcirculation.
CONCLUSION CM are very rare lesions and association with cerebral aneurysms are even rarer. We present a case of a 45years old female patient with multiple cerebral aneurysms 2 years after a successful resection of cardiac myxoma,submitted to radiosurgery for 2 bigger aneurysms with good results.This report adds to literature new clinical findings and a hypothesis of radiosurgery as an effective option oftreatment for cerebral aneurysms with origin in CM. However, randomized controlled trials are essential to addressthis issue and guide therapeutic approach. On the other hand, non-invasive evaluation of the cerebral arteriesshould be done on a regular basis to detect the presence of delayed formation of intracranial aneurysms after theresection of the CM. This is due to the new findings about cerebral vessel involvement with intracranial depositionin cardiac myxomas.
Limitações do estudo Este estudo tem várias limitações. A mais importante delas é o reduzido tamanho da amosta (29 doentes). É, portanto,imperativo que mais estudos sejam realizados para melhor caracterizar o perfil radiológico dos pacientes com doença de Pott.
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