Early and delayed neurological manifestations of cardiac myxomas

•Myxoma histology in brain biopsy can be obscured by inflammatory changes.•Elevated CRP might indicate cardiac myxoma, but not subsequent cerebral manifestations.•Low-dose fractionated whole brain radiotherapy may be helpful for myxoma-related cerebral tumors and aneurysms. Cardiac myxoma can embolize and cause early and delayed sequelae including stroke, growth into intracranial fusiform aneurysms and cerebral tumors with risk of hemorrhage and mass effect. Here, we report the rare coincidence of all these manifestations in a 63-year-old man who presented with cognitive and behavioral changes, and seizures 9 months after an embolic stroke from the heart tumor. C-reactive protein (CRP) was elevated at the time of stroke and cardiac myxoma diagnosis but was normal at late neurologic manifestation with isolated myxoma-related intracranial tumors and aneurysms. Low-dose whole-brain radiotherapy can be helpful to diminish cerebral myxoma tumors and fusiform aneurysms despite reported increased risk of aneurysm rupture.