Cardiac myxoma and its implications for cardioembolic stroke

Table 1 Key points for clinical diagnosis of cardioembolic stroke

Key points	Substance
Clinical features	More common in mid-aged and young women; typical symptoms of cardioembolic stroke
Brain imaging (CT/MRI)	Unilateral multi-territory infarcts (basal ganglia, cerebellum, parietal lobe, and temporal lobe), predominantly involving middle cerebral artery; cerebral hemorrhage or mucinous metastases are rare
Vascular imaging (CTA/MRA, DSA)	A single cerebral artery (especially the MCA) or multiple cerebral arteris stenosis, presenting as multi-segmental occlusion; accompanied by cerebral aneurysms or pseudoaneurysms
Cardiac findings	Confirmed cardiac myxoma
Laboratory findings	Increased serum level of erythrocyte sedimentation rate and C-reactive protein
Differential diagnosis	Exclusion of other diseases

CT: Computed tomography; MRI: Magnetic resonance imaging; DSA: Digital subtraction angiography; MCA: Middle cerebral artery; CTA: Computed tomography angiography; MRA: Magnetic resonance angiography; CM-IS: Cardiac myxoma-induced stroke.

Table 2 Summary of major case series and cohort studies on cardiac myxoma-related ischemic stroke from the neurological literature

Ref.	Country	Sample size	Mean age (years)	Sex (male/female)	Tumor location	Neurological manifestations	Diagnostic modalities
Ekinci EI and Donnan[57], 2004	Australia	72	48	28/44	LA (90%), RA (10%)	Ischemic stroke, TIA, seizures	TTE, TEE, MRI
Zhang et al[21], 2021	China	37	46	16/21	LA (95%), RA (5%)	Multiple territory infarcts, recurrent emboli	MRI, CTA, TEE
Wu et al[45], 2024	China	15	50	6/9	LA (87%), RA (13%)	Large vessel occlusion	MRI, DSA, MT
El Sabbagh et al[29], 2017	United States	12	49	5/7	LA (100%)	Stroke, systemic embolism	TTE, TEE, MRI
Takach et al[58], 1998	United States	19	45	8/11	LA (84%), RA (16%)	Stroke, embolic events	Echo, MRI

LA: Left atrium; RA: Right atrium; TTE: Transthoracic echocardiography; TEE: Transesophageal echocardiography; MRI: Magnetic resonance imaging; CTA: Computed tomography angiography; DSA: Digital subtraction angiography; MT: Mechanical thrombectomy; TIA: Transient ischemic attack.