Cerebral aneurysms one year after resection of a cardiac myxoma

A 40-year-old Caucasian woman was referred to the outpatient clinic of the cardiology department for analysis of a possible cardiac embolus. She was dyspnoeic on exertion, functional class NYHA III/IV and had complaints of malaise and fever. Earlier she had been analysed by internal medicine for the fever and malaise. No cause was found, but on CT abdomen an infarction of the spleen and liver was seen. A transthoracic echocardiogram showed a large mass in the left atrium with obstruction of the mitral valve and pulmonary hypertension (Fig. 1). The diagnosis of cardiac myxoma was made and the patient was referred for resection of the mass. This proceeded without complications and pathological analysis confirmed the diagnosis of myxoma. Soon after this, her complaints resolved completely and the laboratory results returned to normal. A follow-up transthoracic echocardiogram showed no indications of a reoccurrence. One year later she presented to the emergency department with complaints of sensory loss in her tongue and face, and word finding difficulty. These complaints had existed for 1 week and had already partly resolved. Neurological examination was without further abnormalities. A CT scan showed six haemorrhagic lesions in the right cerebral hemisphere. A following MRI scan of the brain also showed multiple haemorrhagic lesions and was suggestive for cerebral micro-aneurysms (Fig. 2). A transthoracic echocardiogram showed no signs of recurrence of the myxoma. There were also no indications of vasculitis. Cerebral angiography showed micro-aneurysms in the right middle cerebral artery (Fig. 3). The diagnosis myxoma-related cerebral micro-aneurysms was made. These findings and the management options were discussed with the department of neurosurgery and it was decided to treat her conservatively. Up till now she is doing relatively well. Her complaints have largely resolved. She is being treated medically for epileptic seizures and occasionally she suffers from headaches and tingling of her tongue. A follow-up cerebral MRI showed no progression of the lesions.