Cured from a Cardiac Myxoma? Brain Intraparenchymal Hemorrhage in a Patient with a 10-year Successfully Resected Cardiac Myxoma.

BACKGROUND: A cardiac myxoma (CM) is the most common primary tumor of the heart. This case report highlights that for metastatic cardiac myxomas, even after a successful total resection, there is a small but real risk of recurrence that can manifest as late as 10 years after initial tumor resection.

CASE DESCRIPTION: We present the case of a 53-year-old woman who visited the emergency room after a 4-day worsening right-sided weakness. The patient was diagnosed with a left cardiac myxoma 10 years ago and a complete surgical resection was performed at that time. A non-contrast head CT revealed a left parietal hematoma and a contrast CT scan of the head revealed an enlarged left parieto-occipital vein which was subsequently shown to be part of an arteriovenous fistula. After embolization of the fistula was performed, a post procedure brain magnetic resonance image (MRI) showed redemonstration of acute intraparenchymal hemorrhage with vasogenic edema. The history of a previously resected cardiac myxoma and the multifocal distribution of brain lesions opened the possibility of slow-growing metastasis from the previous myxoma.

CONCLUSIONS: Our case report demonstrates the metastatic nature of cardiac myxomas to the central nervous system. Even after successful gross total resection and no local relapsing mass in subsequent ultrasonographic follow-ups. A comprehensive evaluation in the clinical and imaginological grounds is mandatory in order to rule out the presence of myxomatous metastatic disease. Awareness and recognition of the potential neurological manifestations of a metastatic cardiac myxoma will prevent unnecessary diagnostic workup and treatments.