Key result
IV rt-PA for stroke from left atrial myxoma triggers severe fatal brainstem and thalamic hemorrhage.
Why the study?
There are very few case reports describing the outcomes of intravenous thrombolysis in patients with left atrial myxoma presenting with acute ischemic stroke.
Case Report (n=1)
Supports caution with rt-PA in suspected myxoma-related stroke; leaves open safety and alternatives pending larger studies.
Intravenous thrombolysis (IVT) is an accepted therapy in patients with acute ischemic stroke presenting within 3-4.5 hours of symptom onset. Selection of the patient for thrombolysis depends on the careful assessment for the risk of post thrombolysis symptomatic haemorrhage (6.2-8.9%) which may be fatal. Atrial myxomas which are the commonest tumors of the heart are associated with stroke due to tumor/clot embolism. There are very few case reports of IVT and its outcome in patients with atrial myxoma with stroke. Some have reported successful thrombolysis, while others have reported intracerebral bleeding. In this report we describe our experience of IVT in atrial myxoma patient with ischemic stroke and review the relevant literature.
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Kulkarni et al. (2014) conducted a case report in Acute ischemic stroke associated with left atrial myxoma (n=1). Intravenous recombinant tissue plasminogen activator (rt-PA) was evaluated. Administration of intravenous rt-PA in an elderly woman with acute ischemic stroke and left atrial myxoma resulted in initial improvement followed by a severe brainstem and thalamic hemorrhage.
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