title: Painful multiple mononeuropathy as a first symptom of cardiac myxoma: an unusual clinical presentation.
abstract: BACKGROUND
  Atrial myxoma (AM) is responsible for multiple serious complications, such as ischemic stroke, and requires cardiac surgery. However, diagnosis and, thus, treatment may be delayed by an initial misleading clinical presentation including nonspecific extracardiac symptoms. Involvement of the peripheral nervous system as a first symptom of AM has been reported only once before and never in the form of multiple mononeuropathy.
  
  
  METHODS
  We report the case of a 51-year-old woman who had suffered from pharmacoresistant neurological pain sequentially in several peripheral nerve territories for more than a year before the appearance of purpuric macules on the palms and soles and emergence of a biological inflammatory syndrome. Cardioembolic disease was suspected after radiological examination detected multiple asymptomatic renal and splenic infarctions and a small right frontal cortical ischemic stroke. Transoesophageal echocardiography revealed an atrial mass which was removed by surgery. AM was confirmed after histopathological analysis. The neurological pain resolved along with embolic and systemic signs of AM, and the patient has since been free of pain.
  
  
  CONCLUSIONS
  Multiple mononeuropathy is a possible symptom of AM and may precede onset of other embolic or systemic signs by several months.
authors.affiliation: Department of Neurology, CHU Nancy, Hôpital Central, 29 avenue du Marechal de Lattre de Tassigny-CO n° 34 54035 Nancy Cedex, France.
authors.forename: Maude
authors.initials: M
authors.lastname: Michaud
authors.affiliation: Department of Neurology, CHU Strasbourg, Hôpital de Hautepierre, 1 avenue Molière 67098 Strasbourg Cedex.
authors.forename: Valérie
authors.initials: V
authors.lastname: Wolff
authors.affiliation: CH Bar le Duc, 1 boulevard d'Argonne 55012 Bar le Duc Cedex, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Pelletier
authors.affiliation: CH Bar le Duc, 1 boulevard d'Argonne 55012 Bar le Duc Cedex, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Evon
authors.affiliation: Department of Neurology, CHU Nancy, Hôpital Central, 29 avenue du Marechal de Lattre de Tassigny-CO n° 34 54035 Nancy Cedex, France. Electronic address: s.richard@chu-nancy.fr.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Richard
mesh_terms: D017548:Echocardiography, Transesophageal; D005260:Female; D006338:Heart Neoplasms / Q000150:complications*; D006801:Humans; D008875:Middle Aged; D020422:Mononeuropathies / Q000209:etiology*; D009232:Myxoma / Q000150:complications*; D009437:Neuralgia / Q000209:etiology*; D011693:Purpura / Q000209:etiology
keywords: Atrial myxoma; Cardiac surgery; Multiple neuropathy; Purpura