title: Neuroimaging Findings in Cardiac Myxoma Patients: A Single-Center Case Series of 47 Patients.
abstract: OBJECTIVE
  Cardiac myxomas can present with a myriad of neurological complications including stroke, cerebral aneurysm formation and metastatic disease. Our study had two objectives: (1) to describe the neuroimaging findings of patients with cardiac myxomas and (2) to examine the relationship between a history of embolic complications secondary to myxoma and intracranial aneurysm formation, hemorrhage and metastatic disease. We hypothesized that patients who present with embolic complications related to myxoma would be more likely to have such complications.
  
  
  METHODS
  We searched our institutional database for all patients with pathologically proven cardiac myxomas from 1995 to 2014 who received neuroimaging. Neuroimaging findings were categorized as acute ischemic stroke, intracerebral hemorrhage, oncotic aneurysm, and cerebral metastasis. Cardiac myxoma patients were divided into those presenting with embolic complications (i.e. lower extremity emboli or cerebral emboli) and those presenting with non-embolic complications prior to surgical resection of the myxoma. The prevalence of intracranial hemorrhage, myxomatous aneurysm formation, and cerebral metastases was compared in myxoma patients presenting with and without embolic complications using a Chi-squared test.
  
  
  RESULTS
  Forty-seven consecutive patients were included in this study. Sixteen patients (34.0%) had imaging evidence of acute ischemic stroke. Of these, 13 had acute ischemic strokes directly attributed to the cardiac myxoma (27.7%) and 3 had acute ischemic strokes secondary to causes other than myxoma (6.4%). Seven patients (14.9%) had aneurysms. Two patients (4.3%) had parenchymal metastatic disease on long-term imaging. Fourteen patients (29.8%) presented with ischemic symptoms that were attributed to cardiac myxoma (1 with lower extremity ischemia, 1 with lower extremity ischemia and ischemic stroke, and 12 with ischemic stroke). Patients presenting with embolic complications related to the myxoma (ischemic stroke or lower extremity ischemia) were more likely to have imaging evidence of intracranial hemorrhage (21.4 vs. 3.0%, p = 0.09), oncotic aneurysm (35.7 vs. 6.1%, p = 0.03), and cerebral metastasis (14.3 vs. 0.0%, p = 0.07) on follow-up imaging.
  
  
  CONCLUSIONS
  Ischemic stroke and intracranial oncotic aneurysm were found in a substantial proportion of cardiac myxoma patients undergoing neuroimaging. Patients presenting with embolic complications of cardiac myxoma are more likely to have intracranial hemorrhage, intracranial oncotic aneurysms, and cerebral metastatic disease.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minn., USA.
authors.forename: Waleed
authors.initials: W
authors.lastname: Brinjikji
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Morris
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brown
authors.forename: Kent R
authors.initials: KR
authors.lastname: Thielen
authors.forename: John T
authors.initials: JT
authors.lastname: Wald
authors.forename: Caterina
authors.initials: C
authors.lastname: Giannini
authors.forename: Harry J
authors.initials: HJ
authors.lastname: Cloft
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Wood
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction; D001706:Biopsy; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology; D001932:Brain Neoplasms / Q000453:epidemiology / Q000556:secondary*; D002533:Cerebral Angiography / Q000379:methods; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000453:epidemiology; D016208:Databases, Factual; D017548:Echocardiography, Transesophageal; D005260:Female; D006338:Heart Neoplasms / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000453:epidemiology; D020766:Intracranial Embolism / Q000175:diagnosis / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008910:Minnesota / Q000453:epidemiology; D009232:Myxoma / Q000453:epidemiology / Q000473:pathology*; D059906:Neuroimaging / Q000379:methods*; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D055815:Young Adult