左房粘液腫による心原性脳塞栓症の1例

Ischemic Stroke Induced by a Left Atrial Myxoma

はじめに

　左房粘液腫は最も頻度の高い心臓腫瘍であり，しばしば心原性脳塞栓症の原因となる¹⁾。これまで左房粘液腫による脳塞栓に対し，経静脈的血栓溶解療法〔rt-PA（recombinant tissue plasminogen activator）療法〕を施行した症例は必ずしも多くない^2-7)。加えて，その根治療法は開心腫瘍摘出術であるが，脳梗塞から手術までの期間の患者管理について明確な指針はない。

　今回筆者らは，心原性脳塞栓症を疑いrt-PA療法を施行後，左房粘液腫による脳梗塞と診断した症例を経験した。左房粘液腫に伴う脳梗塞に対する抗血栓療法の是非を含めて報告する。

Abstract

　We reported a case of ischemic stroke induced by a left atrial myxoma. A 76-year-old man was found unconscious and transferred to the emergency ward in our hospital. He experienced consciousness disturbance, motor dominant aphasia, and severe right hemiparesis. His neurological and radiological findings indicated that he had ischemic stroke and was eligible to undergo intravenous thrombolysis. Alteplase was administrated 155 min after the onset of stroke. Intracerebral hemorrhage was not seen 24h after thrombolysis. A tumor in the left atrium was detected on transthoracic echocardiography, and this finding suggested that the tumor was a myxoma. Although cardiac surgery was scheduled, hemorrhagic transformation was found on day 11, which made us postpone the surgery. After the hemorrhage was disappeared, the tumor was resected by open-heart surgery and it was confirmed to be a myxoma. Neither his neurological symptom nor intracerebral hemorrhage was not deteriorated after the operation. Thrombolytic treatment seemed a safe option for ischemic stroke caused by left atrial myxoma. However, we should carefully monitor the extent of anticoagulation therapy because hemorrhagic transformation might alter the timing of surgery for tumor resection.

(Received: April 4, 2012, Accepted: April 12, 2012)