title: Cerebral infarction due to cardiac myxoma developed with the loss of consciousness immediately after defecation-a case report.
abstract: A 74-year-old man lost consciousness immediately after defecation. The loss of consciousness lasted for several minutes, and he experienced difficulty in walking when he regained consciousness. He was transferred to our hospital via an ambulance. Upon neurological examination, nystagmus and ataxia in the left arm and leg were noted. An MRI of the brain revealed multiple acute infarcts mainly in the bilateral cerebellum. Intravenous thrombolytic therapy with alteplase was initiated 3 h and 20 min after the onset of symptoms, and an improvement in neurological symptoms was observed. Echocardiography displayed a mobile mass in the left atrium, suggesting myxoma. After 14 days from the onset of symptoms, the tumor was surgically resected, and a pathological diagnosis of myxoma was established. Because of the unique event surrounding the onset in this case, we considered that there was a potential detachment of myxoma and/or thrombi fragments triggered by an increase in intrathoracic pressure induced by the action of defecation. This present case suggests that clinicians should consider cardiac myxoma in patients with cerebral infarction if the stroke is preceded by a Valsalva maneuver-like action and accompanied by the loss of consciousness.
authors.affiliation: Department of Neurology, Nagoya City East Medical Center.
authors.forename: Toshimasa
authors.initials: T
authors.lastname: Ikeda
authors.forename: Masahiro
authors.initials: M
authors.lastname: Oomura
authors.forename: Chikako
authors.initials: C
authors.lastname: Sato
authors.forename: Chise
authors.initials: C
authors.lastname: Anan
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yamada
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kamimoto
mesh_terms: D000368:Aged; D002544:Cerebral Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D003672:Defecation / Q000502:physiology*; D004452:Echocardiography; D006338:Heart Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007262:Infusions, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D009232:Myxoma / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D010960:Plasminogen Activators / Q000008:administration & dosage; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D016896:Treatment Outcome; D014474:Unconsciousness / Q000209:etiology*; D014636:Valsalva Maneuver / Q000502:physiology
chemical_list: D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator