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Central and peripheral fusiform aneurysms six years after left atrial myxoma resection
  1. M T Walker1,
  2. R K Kilani2,
  3. L R Toye3,
  4. C R Bird3
  1. 1Northwestern Memorial Hospital, Department of Radiology, Division of Neuroradiology, 676 N St Clair Street, Suite 800, Chicago, Illinois, USA
  2. 2University of Arizona School of Medicine, Tucson, Arizona, USA
  3. 3Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Department of Radiology, Phoenix, Arizona, USA
  1. Correspondence to:
    Dr Matthew T Walker,
    mwalker{at}radiology.northwestern.edu

https://doi.org/10.1136/jnnp.74.2.281

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    Central nervous system embolisation of left atrial myxoma is well documented.1 The most common neurological sequel is acute cerebral ischaemia secondary to vessel occlusion by tumour.2 Delayed neurological complications are much less common and may result from tumour recurrence with embolisation, progressive vascular stenosis, aneurysm formation with subsequent rupture, or parenchymal metastasis.2 We report the occurrence of multiple myxomatous aneurysms in a patient six years after resection of a left atrial myxoma who was experiencing transient ischaemic attacks in the same distribution as the largest aneurysms. These lesions included bilateral fusiform aneurysms of the superior cerebellar and posterior cerebral arteries.

    Case report

    A 60 year old woman had a two week history of progressive occipital headache, intermittent visual changes, right facial pain, and imbalance. On examination, she had mild left upper and lower extremity weakness and mild cerebellar asymmetry. The patient reported a history of left atrial myxoma resection six years before presentation. Atherosclerotic risk factors included remote tobacco use and raised serum cholesterol. Pertinent drug treatment included fluvastatin and clopidogrel.

    Magnetic resonance imaging (MRI) of the brain suggested aneurysms of the superior cerebellar arteries or posterior cerebral arteries. The MRI also revealed areas of previous infarction in multiple vascular distributions including the left superior cerebellar artery and both posterior cerebral arteries. Digital subtraction angiography showed large irregular fusiform aneurysms of the proximal superior cerebellar arteries (fig …

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    Footnotes

    • Competing interests: none declared