title: Safe and effective intravenous thrombolysis for acute ischemic stroke caused by left atrial myxoma.
abstract: Atrial myxoma may be associated with syncope or sudden death attributed to left-sided cardiac outflow obstruction or embolization caused by tumor dislodgement or thrombus formation. Definitive treatment for primary and secondary stroke prevention is surgical resection. The role of thrombolysis in acute brain ischemia in patients with atrial myxoma is not defined. There are few data available regarding safety and efficacy of thrombolytic therapy in acute ischemic strokes caused by atrial myxoma. Prior case reports described partial success using intra-arterial local thrombolysis; however, this is invasive and can be associated with significant complications. A previously reported case of systemic thrombolysis resulted in development of cerebral hemorrhage. We describe a young man who presented with syncope and a dense stroke developing as a complication of atrial myxoma, followed by a remarkable recovery after treatment with intravenous recombinant tissue plasminogen activator and urgent cardiac surgery. Contrary to some expert opinion, systemic thrombolytic therapy may be safely and effectively used to treat acute ischemic strokes from atrial myxoma.
authors.affiliation: Division of Cardiology, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Nagy
authors.forename: Michael
authors.initials: M
authors.lastname: Levy
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Mulhearn
authors.forename: Maryam
authors.initials: M
authors.lastname: Shapland
authors.forename: Henry
authors.initials: H
authors.lastname: Sun
authors.forename: David D
authors.initials: DD
authors.lastname: Yuh
authors.forename: Dickson
authors.initials: D
authors.lastname: Cheung
authors.forename: Nisha
authors.initials: N
authors.lastname: Chandra-Strobos
mesh_terms: D000208:Acute Disease / Q000628:therapy; D000328:Adult; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002545:Brain Ischemia / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D006348:Cardiac Surgical Procedures; D002536:Cerebral Arteries / Q000187:drug effects / Q000473:pathology / Q000503:physiopathology; D017548:Echocardiography, Transesophageal; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D006338:Heart Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D006801:Humans; D007275:Injections, Intravenous; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D009232:Myxoma / Q000150:complications* / Q000473:pathology / Q000601:surgery; D020521:Stroke / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D010959:Tissue Plasminogen Activator