再発性，多発性脳塞栓を呈したleft atrial myxomaの1例

AN AUTOPSIED CASE OF LEFT ATRIAL MYXOMA WITH REPEATED MULTIPLE CEREBRAL EMBOLI

I．はじめに

　心臓腫瘍の大部分は転移性腫瘍で，心原発性のものは極めて少ない^2,16）。myxomaはその50％を占る。約75％は左心房に発生する^16）。好発年齢は30〜60代であるが，いずれの年齢でもみられる^12）。myxomaの臨床症状としては，心臓の閉塞徴候，全身症状，系統的塞栓などであるが^5〜7），脳卒中様症状で初発することもある^8〜11）。myxomaに関する本邦の文献は少なく，特に臨床神経学の立場からの報告は見当らない。著者らは初期に心症状を認めずに，脳卒中発作を初発症状として発症し，再発性，多発性脳塞栓を呈して，4年7カ月の経過で死亡したleft atrial myxomaの1例を経験したので，若干の文献的考察を加えて報告する。

A case of left atrial myxoma with repeated mu-ltiple cerebral emboli is reported.

A-44-year-old man first developed a sudden right hemiparesis in October 1969. After intensive phy-sical theraphy, strength improved and he was able to return to his work. In March 1970, he suddenly lost consciousness and remained comatose for a day. Upon waking, he had a profound right hemiparesis, motor aphasia and Gerstmann's syndrome. He was admitted to Hiroshima City Hospital on August 1, 1970. The cardiac examination, including an ele-ctrocardiogram, was entirely normal. Laboratory studies revealed a normal blood count and urinal-ysis; erythrocyte sedimentation rate was elevated (32mm/hour). On a left cerebral angiographic stu-dy, performed on September 6, 1971, multiple an-eurysmal dilatations of the branches of the left mi-ddle cerebral artery were demonstrated. No specific diagnosis was made. In January 1973, he developed dysarthria, dysphagia and quadriplegia because of the reccurent cerebral attacks. He had a high te-mperature continuously for three days and died on-May 30, 1974.

At autopsy a myxoma with the peduncle was attached to the septal wall of left atrium, and the-re were old infarcts in the brain, the myocardium and the kidneys.