左心房黏液瘤并发脑卒中的临床表现及影像学特征分析

Clinical manifestations and imaging features of left atrial myxoma complicated with cerebral apoplexy

目的探讨左心房黏液瘤并发脑卒中的临床特点及影像学特征。方法回顾性分析海军军医大学附属长海医院2010年1月至2018年12月共156例经术后病理证实的心脏黏液瘤病人,从中遴选出并发脑卒中的病人22例,分析其临床表现、影像学特征及相关诊疗情况。结果脑卒中均发生在左心房黏液瘤病人中(141例),发生率15.6%(22/141),其中男性7例,女性15例,最小27岁,最大74岁。22例脑卒中病人均为脑栓塞,其中合并脑出血3例,合并颅内多发动脉瘤2例,无单纯脑出血病人。影像学检查显示发生在前循环供血区5例,发生在后循环5例,前后循环均受累12例;其中77.27%(17/22)的脑栓塞为多灶性;72.73%(16/22)病灶累及大脑皮层。其中2例病人在急性期行溶栓治疗,症状均有改善。2例合并动脉瘤的病人均行开颅手术切除,术后病理可见黏液瘤成分。结论伴左心房黏液瘤的脑卒中病人以脑栓塞最为常见,临床表现多为肢体无力、晕厥及失语等;影像学上可见病灶大部分呈多发性、累及皮层,部分病人可见出血转化,可出现颅内多发动脉瘤。手术切除是治疗及预防再发的最佳方案。

Objective To explore the clinical and imaging features of left atrial myxoma complicated with cerebral apoplexy.Methods One hundred and fifty-six patients with cardiac myxoma who were confirmed by postoperative pathology in Shanghai Changhai Hospital from January 2010 to December 2018 were retrospectively analyzed.22 patients complicated with cerebral apoplexy were selected to analyze their clinical manifestations,imaging characteristics,diagnosis and treatment.Results Patients with cerebral apoplexy occurred in the population with left atrial myxoma(141 cases),with an incidence of 15.6%(22/141),including 7 males and 15 females.All of the 22 patients had cerebral embolism,including 3 patients with cerebral hemorrhage and 2 patients with multiple intracranial aneurysms,no patients with intracerebral hemorrhage only.Imaging examination showed that 5 cases occurred in the anterior circulation,also 5 cases occurred in the posterior circulation,12 cases were involved both in the anterior and posterior circulation.Among them,77.27%(17/22)patient had multifocal cerebral embolism,and the lesion of 72.73%(16/22)patients involved cerebral cortex.Two patients were treated with intravenous thrombolytic therapy in the acute phase,and their symptoms were alleviated.Two patients with aneurysms underwent craniotomy,and postoperative pathology showed myxoma components.Conclusions Cerebral embolism is the most common in stroke patients with left atrial myxoma,and the clinical manifestations are limb weakness,syncope and aphasia.Imaging findings show that most of the lesions are multiple and involve in the cortex,and hemorrhage transformation is observed in some patients,with multiple intracranial aneurysms.Surgical resection is the best method to treat and prevent recurrence.