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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 28, No 5, September/October 2017
AFRICA
e1
Case Report
Atrial myxoma: a rare cause of hemiplegia in children
Uchenna Onubogu, Boma West, Boma Orupabo-Oyan
Abstract
Background:
Atrial myxoma is an uncommon cause of hemi-
plegia in children. However hemiplegia is the commonest
manifestation of atrial myxoma in the paediatric age group.
Case report:
An 11-year-old girl presented with left hemi-
plegia and palpitations. Three months later she had a deep-
vein thrombosis of the right common iliac vein. MRI of
the brain showed a subacute right thalamic infarct, and an
ECG showed left atrial and left ventricular hypertrophy.
Transthoracic echocardiography revealed a left atrial myxoma
impinging on the mitral valve. A diagnosis of left atrial
myxoma with multiple thromboembolic events was made. She
was placed on anticoagulants until she died while awaiting
surgical tumour resection.
Conclusion:
Echocardiography should be done early in chil-
dren presenting with ischaemic thromboembolic diseases in
order to reduce morbidity and mortality rates resulting from
cardiac pathology.
Keywords:
atrial myxoma, hemiplegia, thromboembolic, cardiac,
children
Submitted 17/5/16, accepted 30/10/16
Published online 9/12/16
Cardiovasc J Afr
2016;
27
: e1–e3
www.cvja.co.zaDOI: 10.5830/CVJA-2016-093
Cardiac myxoma is a rare cause of cerebrovascular disease
(CVD), especially in children. The common cause of CVD in
African children is sickle cell disease.
1
Other common causes are
cyanotic congenital heart diseases, arrhythmias, coagulopathies
and systemic infection (meningitis, sepsis).
1,2
The term myxoma is the Latin translation of a Greek word
‘muxa’, which literally means mucus. A cardiac myxoma is a
benign tumour of the heart arising from primitive mesenchyme.
Cardiac myxoma is the most common primary tumour of
the heart in adults but is very infrequent in the paediatric
population.
3
Among primary cardiac tumours in children, the
rhabdomyomas are the commonest.
4
Cardiac myxomas can be seen in any of the cardiac chambers
but rarely on the heart valves. The atria are more affected
than the ventricles, therefore cardiac myxomas are said to be
predominantly intra-atrial. About 90% of cardiac myxomas are
located in the atria with a left-to-right ratio of about 4:1.
5
Our
patient had a left atrial cardiac myxoma. The size of a cardiac
myxoma can range from small (unnoticeable) to as large as 8 cm
in length.
Case report
An 11-year-old girl was referred to the cardiology clinic
on account of left hemiplegia of one month duration. The
hemiplegia was of sudden onset and was associated with
headache, dizziness and vomiting at onset. She had also been
having intermittent episodes of palpitations and had just
been discharged from hospital two weeks earlier after being
managed for an intracranial space-occupying lesion, with raised
intracranial pressure, left hemiplegia and multiple cranial nerve
palsy. She had a positive history of sudden death in her family
(an uncle and her grandmother).
On examination, she had a hemiplegic gait, a left CN V1,
VII palsy and decreased power, tone and reflexes in the left
upper and lower limb. A regular pulse and wide blood pressure
difference was noted in both right and left upper limbs (right
120/50 mmHg, left 60 mmHg/unrecordable).
Previous tests had been done when she was admitted. MRI
of the brain showed subacute right thalamic infarct, and her
blood lipid profile and random blood glucose results were
normal. Her genotype was AA, mantoux was negative, chest
radiograph was normal, and PT/PTTK was also normal.
A diagnosis of peripheral artery disease was entertained and
magnetic resonance angiography of both carotid arteries was
done, which was normal. The ECG showed sinus rhythm with
evidence suggestive of left atrial and left ventricular hypertrophy.
An echocardiography could not be done immediately but was
requested.
She was subsequently placed on aspirin, encephabol and
regular physiotherapy while angiography was being awaited.
She defaulted from follow up and was seen in hospital three
months later when she collapsed at school after complaining
of heaviness of the right side of the body and inability to walk.
Her history revealed that she had stopped her aspirin two days
earlier.
On examination, she was conscious, and the blood pressure
in both upper limbs was equal and normal (110/70 mmHg). Her
pulse was a good volume but irregularly irregular, both legs were
cold to the touch, and the dorsalis pedis was barely palpable. A
diagnosis of deep-vein thrombosis was entertained.
Braithwaite Memorial Specialist Hospital, Portharcourt,
Rivers, Nigeria
Uchenna Onubogu, MB BS, FWACP,
utchayonubogu@yahoo.co.ukBoma West, MB BS, FWACP
Boma Orupabo-Oyan, MB BS, FWACP