Brain aneurysm associated with atrial myxoma. (P6.208)

Objective: To describe a patient with brain aneurysm associated with atrial myxoma with spontaneous resolution after tumor removal. Background: Atrial myxoma is the most common cardiac tumor and is a rare cause of stroke. It is a common cause of ischaemic and hemorrhagic strokes, but in 10–15% of cases it is associated with development of metastatic aneurysms, predominantly in the territory of the middle cerebral artery. The management of these patients is complex, since the only effective treatment is surgical removal, which involves extracorporeal circulation anf flow disturbances that can lead to rupture of aneurysms. Design/Methods: Case report. Results: A 46-year-old female patient underwent a transthoracic echocardiogram, while on investigation due to an ischaemic stroke, which showed several irregular fragments of tissues measured together 11.0 × 6.0 × 2.0 cm, adhered to the mitral valve suggestive of a atrial myxoma. During the anesthetic induction to remove the myxoma, she developed an acute left hemiparesis and the surgery was interrupted. Brain CT angiography showed a hipodense lesion in the right middle cerebral artery (MCA) territory suggestive of acute infarction and two cerebral aneurysms in the M2 and M4 segments of the same artery. He underwent cardiac surgery after three weeks of the event without complications. The Brain CT angiography performed 18 days after the procedure showed complete regression of the aneurysms. She was discharged home for follow-up. Conclusions: Atrial mixomas can lead to stroke thoughout several mechanisms including the development of brain aneurisms secondary to metastatic invasion of the vessel wall. The treatment of these aneurysms is often expectant, with no need of direct surgical approach since lesions may shrink upon removal of the cardiac mass. The use of thrombolytics in myxoma ischemic stroke is controversial. The tumor recurrence rate varies from 1–5% and close clinical follow-up is necessary. Study Supported by: NA Disclosure: Dr. Coutinho has nothing to disclose. Dr. Graciani has nothing to disclose. Dr. Afonso has nothing to disclose. Dr. Teixeira has nothing to disclose. Dr. Haynes has nothing to disclose. Dr. Oliveira has nothing to disclose. Dr. Lima has nothing to disclose.