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 par ents 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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