Abstract
The role of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke in patients with left atrial myxoma is still unknown. A 72-year-old man was admitted to our hospital because of consciousness disturbance and left hemiparesis. Neurological examination on admission revealed disturbance of consciousness (Japan Coma Scale I-1), dysarthria, conjugate deviation to right, left hemiparesis (manual muscle testing [MMT]: 0–1/5) and sensory impairment. Cranial CT scan showed early CT sign of brain ischemia. Diffusion weighted magnetic resonance imaging showed high intensity in the right middle cerebral artery territory. Magnetic resonance angiography demonstrated incomplete right internal carotid artery occlusion. Since he was diagnosed as having a cardioembolic infarction, treatment with intravenous 0.6mg/kg tPA was started 100 minutes after the onset. Thirty minutes after infusion, MMT of his left lower limb was improved from 1/5 to 1–2/5. Cardiac ultrasonography suggested a left atrial myxoma, which was resected later and confirmed histologically. The present case was the third case of acute cerebral infarction associated with left atrial myxoma treated by intravenous tPA. Further clinical investigations are needed to estimate the safety and efficacy of tPA in acute ischemic stroke in patients with left atrial myxoma.
