Cerebral Aneurysm in Association with Left Atrial Myxoma

[...]history did not reveal personal or family history of aneurysms or disorders associated with cerebral aneurysm formation, such as Ehlers–Danlos syndrome or autosomal dominant polycystic kidney disease. Myxoma is associated with the broad clinical triad of cardiac presentation (60%), sequelae of cerebral or systemic embolization (30–40%), and constitutional symptoms (30%).1 Transthoracic echocardiography is generally used initially, but transesophageal echocardiography is a superior method for diagnosing this condition.2 The mainstay of treatment for myxoma is surgical resection, particularly when the risk of further tumor embolism or valve obstruction is very high.1 The tumor can behave aggressively and tends to recur despite being a benign tumor.3 The mobility, but not the size of the mass, may influence embolic potential.2 Neurological presentations of left atrial myxoma are varied. Stoane et al. proposed a “vascular damage theory” in which temporary occlusion of cerebral vessels by tumor emboli leads to perivascular damage and endothelial scarring, and subsequent aneurysm formation.6 Another theory is the “neoplastic theory” which postulates that hematogenous metastases of myxoma cells penetrate and damage the vessels with subsequent fibroblastic proliferation.7 The latter was supported by histopathological findings in previous reports.8 CTA, magnetic resonance angiography (MRA), and conventional cerebral angiography are all methods that can be used to diagnose myxomatous cerebral aneurysms.