Episodic Central Nervous System Ischemia of Undetermined Cause: Relation to Occult Left Atrial Myxoma

Left atrial myxoma should be considered seriously in patients with unexplained cerebral dysfunction, particularly those in whom there are multiple recurrent cerebral vascular episodes, despite the absence of suggestive heart findings. Substantiating this observation are two such illustrative cases with embolic disease leading to neurological involvement who otherwise lacked cardiac symptomatology and did not exhibit auscultatory, roentgenological or electrocardiographical evidence of heart disease. The first patient died without antemortem recognition of the tumor and, in the second, the myxoma was removed after eventual identification by cardiac angiography and histological examination of embolic material. Thus, it is recommended that left atrial myxoma be definitely sought by heart catheterization with contrast study as a potentially curable cause of chronic nervous system disease with transient episodes of vascular insufficiency even in patients without cardiac manifestations.