Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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December 31, 2020
Multiple Intracranial Myxomatous Aneurysms
- Background:
- Intracranial myxomatous aneurysms after atrial myxoma resection is a rare neurologic complication.This may be due to myxoma tumor cell seeding of the cerebral vessels followed by destruction of the arterial wall.
- Clinical Presentation:
- Neurologic manifestations include headache, hemiparesis, hypoesthesia of limbs, seizures, dysarthria, cerebral ischemia, and so on; may precede cardiac myxoma manifestations; or may present alone.
- Subarachnoid hemorrhage can be observed in association with rupture of aneurysms.
- Key Diagnostic Features:
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Myxomatous aneurysms are characteristically multiple in number, distal in location, fusiform in shape, and show marked enhancement.
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Cerebral angiography is the most sensitive examination. Aneurysms typically appear as focal vascular outpouchings or dilatations, fusiform and/or saccular in morphology, and with delay in the passage of contrast agent.
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Myxomatous aneurysms appear as high density on CT, variable signal intensity on MRI because of complex composition, and characteristically with marked enhancement. Some lesions may show hypointense flow voids.
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- Differential Diagnoses:
- Mycotic aneurysms: presence of predisposing factors such as endocarditis, meningitis, and so on; positive cultures from peripheral blood or the infected aneurysm wall; antibiotic therapy can be effective
- Dissection: intimal flap; narrowed eccentric lumen surrounded by a crescent-shaped mural thrombus and thin annular enhancement
- Collagen vascular disorders: medical and family history; characteristic clinical manifestations in different organs and systems, including the skeletal system, the skin, and so on
- Treatment:
- There are no definite guidelines for treatment of myxomatous aneurysms.
- Resection of cardiac myxomas, radiotherapy, chemotherapy, surgical treatment, and coil embolization may be helpful.
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