Histology of Thrombectomy Specimen Reveals Cardiac Tumor Embolus in Cryptogenic Young Stroke (original) (raw)
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Stroke and Cardiac Papillary Fibroelastoma: Mechanical Thrombectomy after Thrombolytic Therapy
Journal of Stroke and Cerebrovascular Diseases, 2014
We describe a case of a 34-year-old man with a sudden development of right hemiparesis and aphasia because of infarction of the left middle cerebral artery that was submitted to intravenous (IV) recombinant tissue plasminogen activator and mechanical thrombectomy. Transesophageal echocardiogram showed a small mass on the anterior leaflet of the mitral valve. Cardiac surgery was performed, and histological examination of the removed material was consistent with cardiac papillary fibroelastoma (CPF). Experience in using IV thrombolysis for the treatment of embolic stroke because of CPF is limited. To the best of our knowledge, only 3 patients are reported in literature in whom acute ischemic stroke and associated CPF were treated with thrombolytic therapy. A discussion of the efficacy of IV thrombolysis and the possible superiority of mechanical thrombectomy is included.
Embolic Stroke Secondary to Cardiac Papillary Fibroelastoma
The Neurologist, 2008
Introduction: Papillary fibroelastoma is the most common primary cardiac valvular tumor. Historically, papillary fibroelastoma was an incidental autopsy finding, deemed to have no clinical significance. More recently, reports of symptomatic cases of papillary fibroelastoma with complications such as myocardial infarction and stroke suggest it should be considered a potentially dangerous lesion. In this report, we describe the clinical and echocardiographic findings of 3 patients with cardiac papillary fibroelastoma who presented with cerebral vascular events. Objective: To describe the clinical and echocardiographic findings of 3 patients with cardiac papillary fibroelastoma (CPF) who presented cerebral vascular events. Methods: Describe the findings of 3 patients and review of the literature. Results: We report 3 cases with cerebral ischemic events associated with the presence of CPF that were confirmed by histopathological examination. Conclusions: Cardiogenic embolism is recognized increasingly as an important cause of stroke, accounting of 20% of ischemic strokes. Cardioembolic stroke is largely preventable. The likelihood of recurrence is relatively high for most cardioembolic sources and therefore secondary stroke prevention is fundamental. TEE allowed to characterize well-established sources of embolism, and it was the best diagnostic approach in our patients. Magnetic resonance imaging was used in 1 of these patients, while it confirmed the presumptive diagnosis of cardiac tumor. The first-choice treatment of symptomatic CPF is surgical excision which must be performed as early as possible to reduce the risk of early recurrences of embolic events. The use of TEE in the evaluation of cerebral vascular events is not routinely performed, this method must be considered in patients for whom the cause of cerebrovascular ischemia is unclear, after noninvasive neurovascular studies.
Embolic stroke from cardiac papillary fibroelastomas
Stroke, 1988
We describe two patients with cerebral emboli originating from a cardiac papillary fibroelastoma and compared them with six patients reported in the literature. Surgical excision was curative in both of our patients. The surface topography of the tumor, as visualized by scanning electron microscopy, is described.
Cardiac Papillary Fibroelastoma and Stroke in a Young Man – Etiology and Treatment
Cerebrovascular Diseases, 2008
Stroke Notes activities, rheumatoid factor, antinuclear antibody, anticardiolipin antibody and serum VDRL was negative. Chest radiography and electrocardiogram showed no remarkable findings. A transthoracic echocardiogram revealed a mobile mass attached to the chordae of the mitral valve. The transesophageal echocardiogram confirmed the presence of a 2 ! 2 mm pedunculated mobile round mass, attached to the chordae of the posterior leaflet of the mitral valve, the appearance of which was consistent with CPF (fig. 2). Heart MRI was then obtained to characterize the tissue tumor. It demonstrated a round tumor with signal intensity similar to the cardiac muscle on T 1-and T 2-weighted sequences consistent with the presumptive diagnosis of CPF rather than a myxoma (fig. 3). There were neither valve abnormality, intracavitary thrombus, septal defects nor mitral regurgitation. Surgical excision of the tumor was initially proposed as firstchoice treatment. However, due to the intimate relationship between tumor and mitral chordae, the possible need of valvar replacement could not be ignored. The patient refused to undergo surgery, and, alternatively, he has received oral anticoagulation therapy with sodium warfarin. Along a 48-month follow-up period, the International Normalized Ratio varied between the therapeutic interval of 2 and 3. Cardiac function remained stable, and neurological deficits improved slowly (current modified Rankin scale and Barthel index scores both 1); the patient has returned to his daily activities. Control brain MRI after 48 months did not reveal any new asymptomatic infarct lesion (fig. 4).
Left ventricular papillary fibroelastoma. An unusual cause of cerebral emboli
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 1991
We describe the case of a 63-year-old woman with a cardioembolic neurologic deficit secondary to papillary fibroelastoma, a rare intracardiac tumor. Diagnosis was made by use of 2-dimensional and transesophageal echocardiography. The tumor was surgically resected, and the patient had an uneventful recovery. In this report, we discuss the embolic potential of papillary fibroelastoma and the appropriate diagnostic and surgical approaches for patients with this rare disorder.
Papillary fibroelastoma, unusual cause of stroke in a young man: a case report
Journal of cardiothoracic surgery, 2017
Papillary fibroelastoma is the third most common primary benign tumor with an incidence of up to 0.33% in autopsy series; it accounts for approximately 75% of all cardiac valvular tumors. We describe a rare case of a 28-Year-old man that while playing football, had a sudden onset of neurological deficit: aphasia, right hemiparesis and right facial numbness. Transthoracic echocardiography (TTE) showed a 10x10 mm mass attached to the anterior mitral valve leaflet. The patient was treated surgically for the prevention of further embolic complications. Histologic examination of the resected mass revealed a papillary fibroelastoma. It is the third most frequent primary cardiac tumor, after myxoma and fibroma, and the most common primary tumor of heart valves. Despite the benign nature of this tumor, it carries very high risk of embolic complications. The successful complete resection of the papillary fibroelastoma is curative and the long-term postoperative prognosis is excellent. Differ...
Successful Thrombolysis of a Stroke with a Pulmonary Embolism in a Young Woman
The Journal of Emergency Medicine, 2010
Background: Paradoxical embolism is a rare event, accounting for < 2% of all arterial emboli. The diagnosis is often difficult, and consequences for the patient can be severe. Case Report: We describe the case of a 35-year-old female physician who presented to our Emergency Department (ED) in severe hemodynamic compromise, with an altered level of consciousness and major expressive aphasia 1 day after undergoing a leg varicosal stripping procedure under regional anesthesia. She was successfully thrombolyzed with 0.9 mg/kg of Recombinant Tissue Plasminogen Activator (rtPA, Alteplase) and had a full recovery. Conclusion: To our knowledge, this is the first description of a case of massive pulmonary embolism associated with a paradoxical stroke related to patent foramen ovale that was thrombolyzed for both conditions with a "neurological dose" of rtPA. Although thrombolysis was completely successful in this case, indications and contraindications should be thoroughly respected. A more conservative approach with anticoagulation, or a more aggressive approach with surgical thrombectomy, can each potentially have a place in particular cases. Intraarterial catheter-directed thrombolysis and percutaneous embolectomy are additional options to be considered when available, especially if there are contraindications for systemic thrombolysis.
The Search for Cryptogenic Stroke, A Case of Marantic Endocarditis
International Journal of Cardiovascular and Cerebrovascular Disease, 2014
Nonbacterial thrombotic endocarditis (NBTE) is rare and undoubtedly an under-recognized cause of cryptogenic stroke. Its diagnosis relies on a high index of clinical suspicion, particularly in patients with previous malignancy. We present a case of a young woman, with three neurologic events occurring in rapid succession over three weeks, ultimately resulting in her death. The echo imaging findings here appear relatively benign compared to the catastrophic consequences, and speaks of the aggressive fibrin and platelet deposition that can embolize widely in this condition, confirmed on the postmortem examination. We discuss the details of NBTE aiming to increase awareness while assessing patients with undetermined systemic embolization.
Echocardiography-a Journal of Cardiovascular Ultrasound and Allied Techniques, 2006
Since the introduction of echocardiography the diagnosis of papillary fibroelastomas (PFEs) in living patients has increased. They are second most common after myxomas representing 10% of cardiac tumors. The present case is of a patient with recurrent cerebrovascular accidents and documented protein S deficiency who continued to stroke despite adequate anticoagulation. Mitral valve PFE was suspected on echocardiography and confirmed at surgical excision. Two large studies published in the last decade describe the echocardiographic and clinical characteristics of PFEs which although are histologically benign, may present with a clinical course of devastating consequences owing to its strategic location within the cardiac structures. Echocardiography, particularly transesophageal echocardiography (TEE), provides the necessary anatomical resolution and detail to ascertain location, extent of involvement, and hemodynamic implications. Tissue diagnosis is based on characteristic histopathological features of avascular fronds lined by endothelial cells, containing varying amounts of elastin. The echocardiographic characteristics along with treatment options are reviewed.