Abstract

Two cases of atrial myxoma causing migrainous events are described, one of which resolved after surgery for resection of the tumour, one of which persisted. The first case is a 36-year-old lady who initially presented with vasculitic skin lesions. She had migrainous headaches with sensory symptoms and blurred vision over the previous year. She had had migraine as a teenager with visual aura. MRI showed white matter change and enhancing lesions posteriorly. The second case is a 67-year-old man who first had migraine in 2008. He developed episodes lasting 20 min of bilateral arcuate visual scotoma without headache. He presented in 2010 with right hand clumsiness: an MRI showed multiple areas of acute/subacute ischaemia in the left hemisphere. Both underwent Echocardiography which revealed left atrial myxomas (Case 1 had two tumours) which were resected. Case 1 had worsening of her focal neurological events. She had more episodes of visual change, focal sensory loss and headache post-operatively. Repeat imaging revealed improvement of the white matter vasculitic change but increase in enhancing lesions. MR and catheter angiography confirmed fusiform aneurysms, small areas of haemorrhage as well as presumed metastatic myxomatous deposits. Case 2 had complete resolution of his visual symptoms. We review the many neurological complications of atrial myxoma. Migraine is not a well recognised one and as illustrated by these cases, can have different causes and outcomes.