Recurrent Facial Palsy as an Initial Presentation of Cardiac Myxoma

Facial palsy in childhood may result from a variety of diseases. However, it rarely presents initially as cardiac myxoma. In this article, we report on a 12-year-old boy who suffered from recurrent facial palsy as the initial clinical manifestation, which resolved spontaneously within several days of hospital admission. The predisposing factor of the symptom was physical exercise. Brain magnetic resonance imaging showed encephalomalacia and multiple cystic changes compatible with an old infarction over the left caudate nucleus, head-body junction and the left putamen. Echocardiography revealed a tumor mass on the left atrium, and surgical intervention was performed. The pathological finding revealed cardiac myxoma, and a diagnosis of intracardiac myxoma associated with brain infarction and recurrent facial palsies was made. During the three year follow-up, no residual cardiac myxoma or recurrent facial palsy were noted. Although cardiac myxoma associated with stroke rarely occurs in children, it should be considered as a differential diagnosis in patients with paroxysmal neurologic disorders.