Cardiac myxoma and its implications for cardioembolic stroke

Abstract

Cardiac myxoma (CM) is the most common type of primary cardiac tumor and a major embolic source of cardioembolic stroke. Two potential causative mechanisms are associated with CM-related ischemic stroke (CM-IS): Embolism from detached tumor debris and metastatic infiltration. The risk factors for embolism from CM remain unclear and are widely debated in the literature. CM-IS often initially presents with central nervous system complications. Diagnosis requires a comprehensive assessment of clinical manifestations, imaging findings, and laboratory test results, with histopathological examination required for a definitive diagnosis. Surgical resection of myxoma is the most effective CM-IS treatment, although the optimal timing and approach remain controversial. This review consolidates the current knowledge on CM-IS, identifies critical risk factors for embolic complications, and discusses contemporary treatment strategies, emphasizing the need for individualized management protocols and further research to improve outcomes in affected patients.

Keywords: Myxoma; Cerebral embolism; Cardioembolic stroke; Ischemic stroke; Mechanism; Risk factors; Diagnosis; Treatment

Core Tip: Cardiac myxoma, although rare, is a significant cause of cardioembolic stroke in young adults, often due to embolism from tumor fragments or metastatic spread. The link between tumor mobility, morphology, and stroke risk remains unclear. This article explores the relationship between cardiac myxoma and ischemic stroke (CM-IS), highlighting two potential pathogenetic mechanisms and identifying tumor morphology and mobility as critical risk factors. CM-IS predominantly affects younger patients presenting with acute neurological symptoms, necessitating tailored diagnostic and therapeutic approaches. The analysis highlights the complexity of CM-IS and calls for further research to refine its management and support clinical decision making.