Annals of Indian Academy of Neurology
LETTER TO THE EDITOR
Year
: 2015  |  Volume : 18  |  Issue : 3  |  Page : 361--362

"Comments on intravenous thrombolysis in acute ischemic stroke in a known case of left atrial myxoma"


Manish Amarlal Chhabria, Arun Brijratanlal Shah 
 Department of Neurosciences, Sir HN Reliance Foundation Hospital and Medical Research Centre, Mumbai, Maharashtra, India

Correspondence Address:
Arun Brijratanlal Shah
Mentor and Consultant, Department of Neurosciences, Sir HN Reliance Foundation Hospital and Medical Research Centre, Prathna Samaj, Girgaum, Mumbai - 400 004, Maharashtra
India




How to cite this article:
Chhabria MA, Shah AB. "Comments on intravenous thrombolysis in acute ischemic stroke in a known case of left atrial myxoma".Ann Indian Acad Neurol 2015;18:361-362


How to cite this URL:
Chhabria MA, Shah AB. "Comments on intravenous thrombolysis in acute ischemic stroke in a known case of left atrial myxoma". Ann Indian Acad Neurol [serial online] 2015 [cited 2021 Mar 1 ];18:361-362
Available from: https://www.annalsofian.org/text.asp?2015/18/3/361/162304


Full Text

Sir,

We read the paper on "Intravenous thrombolysis in a patient with left atrial myxoma with acute ischemic stroke" by Kulkarni GB, Yadav R, Mustare V and Modi S, published in Annals of Indian Academy of Neurology (Ann Indian Acad Neurol 2014;17:455-8) [1] with great interest.

We congratulate the authors for their efforts in managing this patient. It is commendable on their part to abide by the guidelines in managing a patient who presented with acute ischemic stroke (AIS) in the window period with intravenous thrombolysis.

The fact that she was a known case of left atrial myxoma (LAM), should have been considered prior to thrombolysing her, as fibrinolytic agents cannot lyse myxomatous embolic material. There is no drug treatment for atrial myxoma. The only definite treatment is surgical resection of the tumor. [2]

Cardiac myxomas are associated with intracranial myxomatous aneurysms in which case the aneurysm may rupture [3] because of these reasons antithrombotic and anticoagulants are not indicated in AIS associated with atrial myxoma.

These fusiform aneurysms cannot be clipped because they lack a stem, and the only reported treatment is successful surgical excision. [4] MRI susceptibility-weighted images are three to six times more sensitive than conventional T2-weighted gradient echo images for hemosiderin detection. [5] This technology can be helpful in detecting "unruptured" aneurysms, when there is a suspicion. Patients with cardiac myxoma should be observed for myxoma-related cerebral aneurysms, which can develop and grow [6] even after the tumor is resected. Hence, long-term regular follow-up of these patients is recommended.

We wish to reemphasize the fact that thrombolysis with recombinant tissue plasminogen activator (rTPA) is not indicated for myxoma-related AIS and is in fact harmful, and should not be offered to known patients of myxoma presenting with AIS.

References

1Kulkarni GB, Yadav R, Mustare V, Modi S. Intravenous thrombolysis in a patient with left atrial myxoma with acute ischemic stroke. Ann Indian Acad Neurol 2014;17:455-8.
2English J, Smith W. Handbook of Clinical Neurology, Stroke: Clinical manifestations and pathogenesis part II. Elsevier Health Sciences. Vol. 93 (3rd Series) Ch. 36; 2009. p. 729.
3Sabolek M, Bachus-Banaschak K, Bachus R, Arnold G, Storch A. Multiple cerebral aneurysms as delayed complication of left cardiac myxoma: A case report and review. Acta Neurol Scand 2005;111:345-50.
4Branch CL Jr, Laster DW, Kelly DL Jr. Left atrial myxoma with cerebral emboli. Neurosurgery 1985;16:675-80.
5Mittal S, Wu Z, Neelavalli J, Haacke EM. Susceptibility-weighted imaging: Technical aspect and clinical applications. Part 2. AJNR Am J Neuroradiol 2009;30:232-52.
6Tamuleviciute E, Taeshineetanakul P, Terbrugge K, Krings T. Myxomatous Anaurysms: A case report and literature review. Interv Neuroradiol 2011;17:188-94.