Late Diagnosis of Multiple Cerebral Aneurysms A Decade after Resection of Cardiac Myxoma

Abstract

Cerebral embolism from a cardiac myxoma is a rare cause of ischaemic stroke. These emboli may later lead to the development of cerebral aneurysms. We report a case of delayed presentation of neurological manifestations in form of multiple intracranial aneurysms many years after treatment of a cardiac myxoma. Our patient, a 55-year-old right-handed female with a background history of hypertension, first presented at the age of 45 years with a sudden onset of right hemiplegia. A CT brain scan detected multiple infarcts in the territory of the left middle cerebral artery. Echocardiography revealed a cardiac myxoma for which she underwent immediate total surgical resection. Nearly 10 years after this diagnosis, she presented again with right-sided weakness and left ptosis. CT scan of the brain revealed bilateral acute superior cerebellar infarcts with interval evolution of previously known left cortical infarcts. MRI/MR angiogram showed multiple aneurysms arising from the bilateral middle, left anterior and left posterior cerebral arteries. She was managed conservatively. The management of multiple aneurysms with cardiac myxomas is highly debatable and dependent on the patient’s presentation. This case highlights the importance to follow up on potential late extra-cardiac manifestations of the myxomas despite adequate resection.