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Letters to the Editor

Indian Pediatrics 1999; 36:323-324

Acute Stroke Due to Left Atrial Myxoma


The causes of stroke in children are distinctive from those in adults. Of the Pediatric causes, left atrial myxoma related embolus is rare. We report a case of hemiplegia with bilateral cerebral infarcts due to a silent left atrial myxoma with paucity of cardiovascular findings.

A previously healthy ten years old boy born of second degree consanguineous parents was admitted with history of seizures involving the left side of the body with loss of consciousness. Following this, he developed inability to use both left upper and lower limbs. Examination revealed a conscious patient . with classical signs of left sided hemiplegia and facial palsy with normal higher functions. There was no involvement of cerebellum and sensory system. His BP was 110/70 mm of Hg, pulse was 80 per mintue with a loud first heart sound on auscul­tation. Hemoglobin was 12 g/dl; ESR was normal. The RA factor was negative and there was no biochemical evidence of homo­cystinuria. CT brain showed multiple infarcts involving both middle cerebral artery territo­ries. Echo-cardiograph revealed a large freely mobile mass in the left atrium attached to the atrial septum which descended -into the left ventricle during diastole and returned back into the left atrium during systole. As there were no facilities for surgical intervention in our institutions, the case was referred.

The interesting features in this case are a left atrial myxoma which did not produce any clinical signs and multiple infarcts of both middle cerebral artery territories causing unilateral hemiplegia. The most likely explanation for this is that the infarct on the left side of the brain was not associated with significant edema.

 

                            M. Subramaniant
                               M. Jeganathant
                        P. Suriyanarayanant
                       Antony Rajesh Tilak,

Department of Pediatrics,
Tirunelveli Medical College Hospital,
Tirunelveli 627 011,
India.

 

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