Atrial myxoma: a treatable cause of stroke.

In the search for treatable causes of cerebrovascular occlusion, little emphasis has been given to emboli from left atrial myxomas. Although rare-only 350 cases had been reported by 1965 (Newman, Cordell, and Prichard, 1966)-it is a histologically benign growth that is completely curable if promptly recognized and surgically removed. From various reviews of the clinical manifestations of this neoplasm (Aldridge and Greenwood, 1960; Goodwin, 1963; Silverman, Olwin, and Graettinger, 1962), systemic embolization is known to occur in 40 to 45% of patients. Emboli are frequently multiple and lodge in many sites, but in approximately one-half of the cases the brain is the target organ (Silverman et al., 1962). Joynt, Zimmerman, and Khalifeh (1965) recently analysed 12 case reports of patients with left atrial myxoma in whom acute neurological disturbances-usually hemiplegia, unconsciousness, or both-were the presenting clinical features. Although the average duration of neurological symptoms was over one year, all 12 patients died and in only one case was the correct diagnosis made before death. The present report describes a patient who initially presented as a neurological problem and in whom a left atrial myxoma was correctly diagnosed and successfully treated. Three similar cases are summarized to emphasize the subtle but pertinent clinical features which should suggest this diagnosis in the 'stroke' patient.