Central Retinal Artery Occlusion by Left Atrial Myxoma

Dear Editor, Central retinal artery occlusion (CRAO) is an ophthal-mic emergency and the ocular analogue of cerebral stroke. This condition mostly occurs in patients with high blood pressure, heart disease, diabetes, or carotid artery athero-sclerosis in elderly people [1]. Left atrial myxoma, the most common primary cardiac tumor, is usually fatal unless surgically resected [2]. We report a case of left atrial myx-oma with sudden headache, dizziness, cerebral infarction and retinal artery occlusion as its manifestations. A 25-year-old woman presented with sudden onset headache , dizziness, and vision loss in her left eye for 1 day. The best-corrected visual acuity in her left eye was hand motion and a left relative afferent pupillary defect was noted. She had no medical history. Fundus examination of the left eye showed retinal artery attenuation and whitening of the retina with a cherry-red spot in the fovea (Fig. 1A). Optical coherence tomography of the left eye showed severe edema in the macula and fluorescein angiography of the left eye showed a delay in arterial filling at the early to late phase (Fig. 1B and 1C). The patient was diagnosed with CRAO. During the ophthalmologic examination, the patient complained of persistent headache and vomiting, so she was transferred to the emergency room and received systemic examinations. Laboratory findings showed no abnormalities and her electrocardiogram showed a normal sinus rhythm. Neck computed tomography angiography showed no abnormalities. Brain diffusion-weighted magnetic resonance imaging showed acute multiple signal changes in the left middle cerebral artery territory (Fig. 1D), so she was diagnosed with cerebral infarction. Echo-cardiography showed, there was an intracardiac tumor. Contrast-enhanced chest computed tomography scan showed a heterogeneous mass with fluid density in the left atrium (Fig. 1E). She was transferred to cardiovascular surgery and underwent resection of the mass. An irregular, gelatinous friable mass was surgically removed. Micro-Fig. 1. (A) Fundus photograph of the left eye shows retinal artery attenuation and a cherry-red spot. (B) Optical coherence tomography shows severe edema in the macula. (C) Fluorescein angiography of the left eye shows a delay in arterial filling at 5 minutes 37 seconds. (D) Brain diffusion-weighted magnetic resonance imaging shows acute multiple signal changes (red arrow) in the left middle cerebral artery territory. (E) Contrast-enhanced chest computed tomography scan shows a heterogeneous mass (red arrow) with fluid density in the left atrium. (F) Section from excised tissue shows CD31 positivity in the abundant blood vessels (red …