Limits...
Intravenous Thrombolysis for Embolic Stroke due to Cardiac Myxoma.

Sun MC, Tai HC, Lee CH - Case Rep Neurol (2011)

Bottom Line: No intracranial hemorrhage developed.A cardiac mass was found in the left atrium and removed surgically 84 h after stroke.At the 3-month follow-up, the NIHSS score was 9 and the modified Rankin scale score was 3.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan, ROC.

ABSTRACT
Cardiac myxoma is a rare but curable cause of ischemic stroke. Current guidelines do not address the use of intravenous thrombolysis for embolic stroke caused by cardiac myxoma. The risk of hemorrhage due to occult tumor emboli or microaneurysms is a major concern. We describe a 45-year-old man who had an embolic stroke in the left middle cerebral artery. The initial National Institutes of Health Stroke Scale (NIHSS) score was 16. He received intravenous thrombolysis 2 h and 52 min after stroke onset. No intracranial hemorrhage developed. A cardiac mass was found in the left atrium and removed surgically 84 h after stroke. Pathological study showed a myxoma with extensive hemorrhage and thrombus over the surface. At the 3-month follow-up, the NIHSS score was 9 and the modified Rankin scale score was 3. Our experience with this patient supports the hypothesis that intravenous thrombolysis may be safely used in the treatment of embolic stroke due to cardiac myxoma.

No MeSH data available.


Related in: MedlinePlus

A photomicrograph of the 8.0 × 4.7 × 3.7 cm cardiac tumor removed at the operation (a). Microscopically, polygonal and spindle cells were arranged in a single cord or in nests and embedded in the myxoid stroma (HE) (b). The tumor cells show immunoreactivity to calretinin (immunohistochemical stain, anti-calretinin) (c).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC3064861&req=5

Figure 2: A photomicrograph of the 8.0 × 4.7 × 3.7 cm cardiac tumor removed at the operation (a). Microscopically, polygonal and spindle cells were arranged in a single cord or in nests and embedded in the myxoid stroma (HE) (b). The tumor cells show immunoreactivity to calretinin (immunohistochemical stain, anti-calretinin) (c).

Mentions: A 45-year-old male without known cardiovascular risk factors had a sudden onset of right limb weakness and difficulty in verbal expression. Upon arrival at the emergency department, his blood pressure was 118/74 mm Hg, the heart rate was 82 bpm and regular, and the body temperature was 37.0°C. An electrocardiogram showed sinus rhythm and incomplete right branch bundle block. On X-ray, an enlargement of the cardiac silhouette was noted. The National Institutes of Health Stroke Scale (NIHSS) score was 16 and the head CT scan was normal. All criteria for intravenous thrombolysis were met, thus the patient received 0.9 mg/kg i.v. recombinant tissue plasminogen activator (rtPA, a total of 54 mg) per standard protocol 47 min after arrival at the emergency department and 2 h and 52 min after symptom onset. A follow-up CT scan revealed hypodense lesions in the left basal ganglia and corona radiata without evidence of hemorrhage (fig. 1a). There was no change in the NIHSS score 24 h after treatment. An urgent transthoracic echocardiogram was carried out because of the enlargement of the cardiac silhouette seen on the chest X-ray. A large mass with irregular shape within the left atrium was found. This finding was confirmed with a CT scan of the chest and the heart (fig. 1b). Urgent cardiac surgery was performed 84 h after presentation. A large, reddish, elastic mass, 8.0 × 4.7 × 3.7 cm in size, was removed from the left atrium. The cut surface of the atrial tumor revealed a gelatinous texture with a congested and irregular surface. There was also a cystic degeneration in the central portion (fig. 2a). Microscopically, the irregular surface of the atrial tumor was hemorrhagic and focally coated with blood clots composed of blood cells admixed with fibrinous material. In a high-power field, polygonal and spindle-shaped tumor cells were arranged in a single cord or in nests within the myxoid stroma with some capillary-sized vessels (fig. 2b). The tumor cells were calretinin positive and CD31 negative, which differentiate them from endothelial cells of the granulation tissue or endocardial cells (fig. 2c). The findings were diagnostic of cardiac myxoma. The patient was discharged to receive rehabilitation. At the 3-month follow-up, the NIHSS score was 9 and the modified Rankin scale score was 3.


Intravenous Thrombolysis for Embolic Stroke due to Cardiac Myxoma.

Sun MC, Tai HC, Lee CH - Case Rep Neurol (2011)

A photomicrograph of the 8.0 × 4.7 × 3.7 cm cardiac tumor removed at the operation (a). Microscopically, polygonal and spindle cells were arranged in a single cord or in nests and embedded in the myxoid stroma (HE) (b). The tumor cells show immunoreactivity to calretinin (immunohistochemical stain, anti-calretinin) (c).
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC3064861&req=5

Figure 2: A photomicrograph of the 8.0 × 4.7 × 3.7 cm cardiac tumor removed at the operation (a). Microscopically, polygonal and spindle cells were arranged in a single cord or in nests and embedded in the myxoid stroma (HE) (b). The tumor cells show immunoreactivity to calretinin (immunohistochemical stain, anti-calretinin) (c).
Mentions: A 45-year-old male without known cardiovascular risk factors had a sudden onset of right limb weakness and difficulty in verbal expression. Upon arrival at the emergency department, his blood pressure was 118/74 mm Hg, the heart rate was 82 bpm and regular, and the body temperature was 37.0°C. An electrocardiogram showed sinus rhythm and incomplete right branch bundle block. On X-ray, an enlargement of the cardiac silhouette was noted. The National Institutes of Health Stroke Scale (NIHSS) score was 16 and the head CT scan was normal. All criteria for intravenous thrombolysis were met, thus the patient received 0.9 mg/kg i.v. recombinant tissue plasminogen activator (rtPA, a total of 54 mg) per standard protocol 47 min after arrival at the emergency department and 2 h and 52 min after symptom onset. A follow-up CT scan revealed hypodense lesions in the left basal ganglia and corona radiata without evidence of hemorrhage (fig. 1a). There was no change in the NIHSS score 24 h after treatment. An urgent transthoracic echocardiogram was carried out because of the enlargement of the cardiac silhouette seen on the chest X-ray. A large mass with irregular shape within the left atrium was found. This finding was confirmed with a CT scan of the chest and the heart (fig. 1b). Urgent cardiac surgery was performed 84 h after presentation. A large, reddish, elastic mass, 8.0 × 4.7 × 3.7 cm in size, was removed from the left atrium. The cut surface of the atrial tumor revealed a gelatinous texture with a congested and irregular surface. There was also a cystic degeneration in the central portion (fig. 2a). Microscopically, the irregular surface of the atrial tumor was hemorrhagic and focally coated with blood clots composed of blood cells admixed with fibrinous material. In a high-power field, polygonal and spindle-shaped tumor cells were arranged in a single cord or in nests within the myxoid stroma with some capillary-sized vessels (fig. 2b). The tumor cells were calretinin positive and CD31 negative, which differentiate them from endothelial cells of the granulation tissue or endocardial cells (fig. 2c). The findings were diagnostic of cardiac myxoma. The patient was discharged to receive rehabilitation. At the 3-month follow-up, the NIHSS score was 9 and the modified Rankin scale score was 3.

Bottom Line: No intracranial hemorrhage developed.A cardiac mass was found in the left atrium and removed surgically 84 h after stroke.At the 3-month follow-up, the NIHSS score was 9 and the modified Rankin scale score was 3.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurology, Changhua Christian Hospital, Changhua, Taiwan, ROC.

ABSTRACT
Cardiac myxoma is a rare but curable cause of ischemic stroke. Current guidelines do not address the use of intravenous thrombolysis for embolic stroke caused by cardiac myxoma. The risk of hemorrhage due to occult tumor emboli or microaneurysms is a major concern. We describe a 45-year-old man who had an embolic stroke in the left middle cerebral artery. The initial National Institutes of Health Stroke Scale (NIHSS) score was 16. He received intravenous thrombolysis 2 h and 52 min after stroke onset. No intracranial hemorrhage developed. A cardiac mass was found in the left atrium and removed surgically 84 h after stroke. Pathological study showed a myxoma with extensive hemorrhage and thrombus over the surface. At the 3-month follow-up, the NIHSS score was 9 and the modified Rankin scale score was 3. Our experience with this patient supports the hypothesis that intravenous thrombolysis may be safely used in the treatment of embolic stroke due to cardiac myxoma.

No MeSH data available.


Related in: MedlinePlus