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Images in Neurology |

Multiple Fusiform Intracranial Aneurysms 14 Years After Atrial Myxoma Resection

Alejandro Santillan, MD; Dimitri Sigounas, MD; Matthew E. Fink, MD; Y. Pierre Gobin, MD
Arch Neurol. 2012;69(9):1204-1205. doi:10.1001/archneurol.2011.3503.
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A 68-year-old patient with past medical history significant for an atrial myxoma and multiple transitory ischemic attacks presented with an incidental finding of multiple intracranial aneurysms. The patient underwent resection of the left atrial myxoma in 1997. The results of a cerebral digital subtraction angiography performed 6 months later as part of the workup for a transitory ischemic attack showed no vascular abnormalities (Figures 1A and 2A). Fourteen years following atrial myxoma resection, a computed tomographic angiography was performed for leg weakness following lumbar spine surgery. The results of the computed tomographic angiography revealed multiple, fusiform intracranial aneurysms in the anterior and posterior circulation (Figure 3). Subsequently, a cerebral angiography was performed, demonstrating multiple areas of fusiform dilatation predominantly involving the distal segments of the right anterior and middle cerebral arteries (Figure 1B), as well as the left anterior and middle cerebral arteries, with the largest dilatation arising from the distal posterior division of the left middle cerebral artery (Figure 2B). A transesophageal echocardiogram showed no evidence of myxoma recurrence in the heart. Because the aneurysms were asymptomatic and stable in size on the computed tomographic angiography scan and on a subsequent angiogram, the risk of treatment was deemed too great to undertake prophylactically. The only treatment that could be offered to the patient in the event of the patient's becoming symptomatic secondary to aneurysmal growth or rupture would be aneurysmal trapping, either by surgical or endovascular means. Close annual follow-up using magnetic resonance angiography is recommended.

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Figure 1. Selective angiogram of the right internal carotid artery (lateral view). A, Normal vessels can be seen in 1997. B, Multiple fusiform intracranial aneurysms of the distal segments of the anterior and middle cerebral arteries (arrows) can be seen 14 years later.

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Figure 2. Selective angiogram of the left internal carotid artery. A, Normal vessels can be seen in 1997. B, Fusiform dilatations at the left pericallosal-callosomarginal artery junction and distal posterior division of the left middle cerebral artery (arrows) can be seen 14 years later.

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Figure 3. Computed tomographic angiogram showing multiple fusiform dilatations of the right middle cerebral artery, the calcarine branch of the left posterior cerebral artery, and the superior cerebellar artery (arrows). A indicates anterior; L, left; P, posterior; R, right.

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