Cardiac Myxoma Embolization Causing Ischemic Stroke and Multiple Partially Thrombosed Cerebral Aneurysms

✓ Multiple aneurysm formation secondary to an embolism from the cardiac myxoma is a well-known phenomenon. The cerebral arterial aneurysm formation process involved remains to be elucidated, although occupation of the arterial wall by tumor cells has been proven histologically. The authors present the case of a patient in whom tumor cells in the aneurysm wall were demonstrated and penetration of viable myxoma cells into the wall was also observed 19 months after surgical removal of the cardiac tumor. Such findings have never before been verified histologically. In light of the histological findings, the authors discuss the therapeutic problems associated with cerebral aneurysms resulting from cardiac myxoma.

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Abstract 2779: The Safety of Intravenous Thrombolysis for Ischemic Stroke in Patients With Pre-Existing Cerebral Aneurysms: A Retrospective, Hospital-Based Study

Stroke ◽

10.1161/str.43.suppl_1.a2779 ◽

2012 ◽

Vol 43 (suppl_1) ◽

Author(s):

Nancy Edwards ◽

Hooman Kamel ◽

S. Andrew Josephson

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cerebral Aneurysms ◽

Intravenous Thrombolysis ◽

Aneurysm Rupture ◽

Exact Test ◽

Intravenous Tissue Plasminogen Activator ◽

Unruptured Cerebral Aneurysms ◽

Risk Of Hemorrhage ◽

Iv Tpa

Background and Purpose: Unruptured cerebral aneurysms are currently considered a contraindication to intravenous tissue plasminogen activator (IV tPA) for acute ischemic stroke. This is due to a theoretical increase in the risk of hemorrhage from aneurysm rupture, although it is unknown whether this risk is significant. We sought to determine the safety of IV tPA administration in a cohort of patients with pre-existing aneurysms. Methods: We reviewed the medical records of patients treated for acute ischemic stroke with IV tPA during an 11-year period at two academic medical centers. We identified a subset of patients with unruptured cerebral aneurysms present on pre-thrombolysis vascular imaging. Our outcomes of interest were any intracranial hemorrhage (ICH), symptomatic ICH, and subarachnoid hemorrhage (SAH). Fisher’s exact test was used to compare the rates of hemorrhage among patients with and without aneurysms. Results: We identified 236 eligible patients, of whom 22 had unruptured cerebral aneurysms. The rate of ICH among patients with aneurysms (14%, 95% CI 3-35%) did not significantly differ from the rate among patients without aneurysms (19%, 95% CI 14-25%). None of the patients with aneurysms developed symptomatic ICH (0%, 95% CI 0-15%), compared with 10 of 214 patients without aneurysms (5%, 95% CI 2-8%). Similar proportions of patients developed SAH (5%, 95% CI 0-23% versus 6%, 95% CI 3-10%). Conclusion: Our findings suggest that IV tPA for acute ischemic stroke is safe to administer in patients with pre-existing cerebral aneurysms as the risk of aneurysm rupture and symptomatic ICH is low.

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Abstract WP94: Clinical Outcomes of Unruptured Cerebral Aneurysms Treated With Clipping or Coiling in Japan: The J-aspect Study

Stroke ◽

10.1161/str.47.suppl_1.wp94 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Ataru Nishimura ◽

Kunihiro Nishimura ◽

Akiko Kada ◽

Satoru Kamitani ◽

Ryota Kurogi ◽

...

Keyword(s):

Ischemic Stroke ◽

Postoperative Complications ◽

Clinical Outcomes ◽

Brain Infarction ◽

Cerebral Aneurysms ◽

Nationwide Survey ◽

Mortality Rates ◽

Lower Number ◽

Patient Safety Indicators ◽

Unruptured Cerebral Aneurysms

Background: Evaluation of the overall clinical outcomes of stroke care is important for improving institutional quality of care. We performed a nationwide survey in Japan to analyze cases of unruptured cerebral aneurysms using the diagnostic procedure combination (DPC). Methods and Results: Certified neurosurgical training institutions in Japan provided data from the DPC database on patients hospitalized with neurosurgical diseases between April 1, 2012 and March 31, 2013. Patients hospitalized owing to unruptured cerebral aneurysms were identified from the DPC database based on the International Classification of Diseases (ICD)-10 diagnosis code (I671). We excluded patients with emergency admissions. We compared the mortality rates, modified Rankin Scale (mRS) scores, postoperative complications of patients who underwent clipping and coiling. With respect to postoperative complications, we evaluated the ratio of an event of complication (brain infarction, brain hemorrhage and cardiac infarction) and the number of complications (scored using patient safety indicators: PSIs and hospital-acquired conditions: HACs). We used hierarchical logistic regression models to estimate the odds ratios (ORs) for in-hospital mortality and complications. We identified 6329 patients with unruptured cerebral aneurysms (3710 clipping, 2619 coiling). Patient characteristics, mortality rates, and mRS were similar between groups. Patients who underwent coiling had a significantly lower number of complications than patients who underwent clipping (PSIs: OR = 0.40; P < 0.001, HACs: OR = 0.47; P = 0.001). Adversely, there was an increased likelihood of ischemic stroke in coiling patients compared with clipping patients (coiling: 7.2%; clipping: 4.7%; OR = 1.37; P = 0.011). 83.2% of coiling patients underwent MRI after the operation, compared with 37.3% of clipping patients. Conclusions: Our data demonstrated that coiling patients had lower number of post-operative complications and higher number of ischemic stroke than clipping patients. But the cause that higher number of coiling patients had ischemic stroke than clipping patients because higher number of coiling patients were underwent MRI after operation compared with clipping patients.

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Emergency Excision of Cardiac Myxoma and Endovascular Coiling of Intracranial Aneurysm after Cerebral Infarction

Case Reports in Neurological Medicine ◽

10.1155/2013/839270 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 3

Author(s):

Youssef Al-Said ◽

Heyam Al-Rached ◽

Saleh Baeesa ◽

Khalil Kurdi ◽

Ibrahim Zabani ◽

...

Keyword(s):

Ischemic Stroke ◽

Intracranial Aneurysm ◽

Cerebral Infarction ◽

Left Atrial ◽

Cardiac Myxoma ◽

Artery Aneurysm ◽

Surgical Excision ◽

Endovascular Coiling ◽

Left Atrial Myxoma ◽

Internal Carotid Artery Aneurysm

Cardiac myxoma is the most common primary tumor of the heart, located mainly in the left atrium. Cerebral embolization or intracranial aneurysm formation as a consequence of left atrial myxomas has been well documented, whereas myxoma embolization causing the combination of cerebral infarction and intracranial myxomatous aneurysm is rare. We report herein, a 67-year-old female with a cardiac myxoma who experienced a left hemispheric embolic ischemic stroke and in addition was found to have right internal carotid artery aneurysm. The patient underwent emergency surgical excision of left atrial myxoma 2 hours after the stroke onset and endovascular coiling of the aneurysm a week later. Although the timing of cardiac surgery is controversial in patients who have had recent ischemic stroke, we recommend immediate resection of cardiac myxoma, if feasible, and early endovascular treatment of associated intracranial myxomatous aneurysms.

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Erratum to “Spontaneous thrombosis of cerebral aneurysms presenting with ischemic stroke”

Journal of the Neurological Sciences ◽

10.1016/j.jns.2007.06.001 ◽

2007 ◽

Vol 263 (1-2) ◽

pp. 237

Author(s):

José E. Cohen ◽

Eyal Itshayek ◽

John Moshe Gomori ◽

Savvas Grigoriadis ◽

Guy Raphaeli ◽

...

Keyword(s):

Ischemic Stroke ◽

Cerebral Aneurysms ◽

Spontaneous Thrombosis

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Detection and Significance of Incidental Unruptured Cerebral Aneurysms in Patients Undergoing Intravenous Thrombolysis for Acute Ischemic Stroke

Journal of Neuroimaging ◽

10.1111/j.1552-6569.2010.00560.x ◽

2010 ◽

Vol 22 (2) ◽

pp. 197-200 ◽

Cited By ~ 18

Author(s):

Joon-Tae Kim ◽

Man-Seok Park ◽

Woong Yoon ◽

Ki-Hyun Cho

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Cerebral Aneurysms ◽

Intravenous Thrombolysis ◽

Unruptured Cerebral Aneurysms

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Tissue plasminogen activator for acute ischemic stroke in patients with unruptured cerebral aneurysms

Journal of Stroke and Cerebrovascular Diseases ◽

10.1053/jscd.2000.7213 ◽

2000 ◽

Vol 9 (4) ◽

pp. 181-184 ◽

Cited By ~ 8

Author(s):

Luis D'Olhaberriague ◽

Nishit Joshi ◽

Seement Chaturvedi ◽

Panayiotis Mitsias ◽

William Coplin ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Plasminogen Activator ◽

Tissue Plasminogen Activator ◽

Cerebral Aneurysms ◽

Tissue Plasminogen ◽

Unruptured Cerebral Aneurysms

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Neoplastic cerebral aneurysm from metastatic gestational choriocarcinoma

Journal of Neurosurgery ◽

10.3171/jns.1985.63.4.0644 ◽

1985 ◽

Vol 63 (4) ◽

pp. 644-647 ◽

Cited By ~ 27

Author(s):

Michael Pullar ◽

Peter C. Blumbergs ◽

Gael E. Phillips ◽

Paul G. Carney

Keyword(s):

Intracerebral Hemorrhage ◽

Histopathological Examination ◽

Cardiac Myxoma ◽

Cerebral Aneurysms ◽

Artery Aneurysm ◽

Undifferentiated Carcinoma ◽

Intracerebral Hematoma ◽

Content Type ◽

Gestational Choriocarcinoma ◽

Child Bearing

✓ This case of metastatic gestational choriocarcinoma presented as intracerebral hemorrhage from an atypical distal middle cerebral artery aneurysm. Operative evacuation of the intracerebral hematoma was undertaken and histopathological examination revealed choriocarcinoma invading the vessel wall. Neoplastic cerebral aneurysms are unusual, being reported in metastatic choriocarcinoma, cardiac myxoma, bronchogenic carcinoma, and undifferentiated carcinoma. Metastatic choriocarcinoma should be considered in the differential diagnosis of intracerebral hemorrhage in women of child-bearing age. Recent advances in treatment have resulted in a 75% cure rate for metastatic choriocarcinoma.

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