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Systematic Review

Cerebral Aneurysms Caused by Atrial Myxoma—A Systematic Review of the Literature

Justyna Chojdak-Łukasiewicz
Sławomir Budrewicz
Marta Waliszewska-Prosół
Department of Neurology, Wroclaw Medical University, 50-556 Wroclaw, Poland
Author to whom correspondence should be addressed.
J. Pers. Med. 2023, 13(1), 8;
Submission received: 11 November 2022 / Revised: 11 December 2022 / Accepted: 19 December 2022 / Published: 21 December 2022


Background: The association between cerebral aneurysms and left atrial myxoma is known but rare. We described its pathogenesis, clinical presentation, diagnostic findings and treatment using a systemic review of the literature. Methods: MEDLINE via PubMed was searched for articles published until August 2022 using the keywords “atrial myxoma”, “cardiac myxoma” and “cerebral aneurysm”. Results: In this review, 55 patients with multiple myxomas aneurysms were analyzed, and 65% were women. The average age when aneurysms were diagnosed was 42.5 ± 15.81; most patients were less than 60 years old (86%). Aneurysms could be found before the diagnosis, at the same time as cardiac myxoma, or even 25 years after resection of the atrial mass. In our review, the mean time to diagnoses was 4.5 years. Our review estimates that the most common symptoms were vascular incidents (25%) and seizures (14.3%). In 15 cases, variable headaches were reported. Regarding management strategies, 57% cases were managed conservatively as the primary choice. Conclusions: Although cerebral aneurysms caused by atrial myxoma are rare, the long-term consequences can be serious and patients should be monitored.

1. Introduction

Cardiac myxomas (CM) are the most common benign “cardiac” tumors, accounting for up to 30–50% of all primary heart tumors [1]. The incidence is approximately 0.5–1 cases per 1,000,000 population per year [2]. About 75% concern the left atrium of the heart [3], and 18% originate in the right atrium; biatrial myxomas are rare and account for less than 2.5% of all cardiac myxomas. Myxomas are particularly frequent from the third to the sixth decades of life; the ratio women: men varies from 2:1 to 3:1. CM are diagnosed based on clinical examination and tests such as electrocardiography (ECG), transthoracic echocardiogram (TTE), transesophageal echocardiogram (TEE), chest computed tomography (CT) or magnetic resonance imaging (MRI) and cardiac MRI [4].
Most cardiac myxomas present with constitutional, embolic and obstructive manifestations. Younger and male patients have more neurologic symptoms, and female patients have more systemic symptoms. These can cause many neurological complications, including systemic embolism, cerebral infarction, cerebral cavernous malformations and intracranial aneurysms [5]. Myxoma-related aneurysms are always multiple and in most cases have a fusiform-shape.
Left atrial myxomas are considered curable by complete resection and give excellent results in long-term follow-up. Surgical excision remains the treatment of choice for cardiac myxoma. Early diagnosis and intervention is desirable because of the persistent risk of brain metastases and aneurysms. However, incomplete resection, multifocal tumors and embolism caused by tumors are important factors in its recurrence and complications [3,6]. Currently, our understanding of cerebral aneurysms caused by atrial myxoma is based mainly on case reports.
This systemic review of the literature aimed to provide an exhaustive summary of available case reports evaluating medical history, clinical, diagnostic and therapeutic methods in patients with cerebral aneurysms caused by atrial myxoma.

2. Methods

JCŁ and MWP performed an independent online search in accordance with PRISMA guidelines [7] using the following combination of keywords: “atrial” and “cardiac” and “myxoma” and “cerebral” and “aneurysm” or “myxomatosus” and “cerebral” and “aneurysm”.
We considered publication records from MEDLINE and ERIC databases until August 2022. In addition, the reference lists from eligible publications were searched. All discrepancies were resolved by discussing the results of the preliminary search with a third reviewer (SB) (Figure 1).
A total of 257 records were identified and screened separately by the authors. Then, these record lists were double read by both analysts and 92 abstracts were found to be relevant to the subject. Each researcher worked independently and prepared their own list of relevant full-text manuscripts. Both lists were compared and 54 publications were found to be the most relevant to the study and included in this review. The exclusion criteria were non-English-language articles, conference papers and abstract only.

3. Results

We found 54 case report articles describing 55 patients. All cases are illustrated in Table 1. We did not find any article about type case series or an original work on a larger group of patients. The group consisted of 35 women (64%) and 20 men (36%). The average age when aneurysms were diagnosed was 42.5 ± 15.81 years (the age varied from 11 to 69 years) and 46 of the patients were less than 60 years old (84%).
Aneurysms could be found before the diagnosis, at the same time as cardiac myxoma, or even 25 years after resection of atrial mass. In our review, the mean time to diagnoses was 4.5 years. In 1 patient, the myxoma was localized in both atrial, while in the remaining 54 patients—left atrium.
Our review estimates that the most common symptoms were vascular incidents (TIA, stroke), seizures, vertigo or dizziness and loss of consciousness. In 15 cases, variable headaches were reported—most often they had the migraine phenotype with visual disturbances. Three patient presented clinical symptoms typical of subarachnoid hemorrhage and two had no symptoms (Table 2).
Based on our analyses, trial myxoma-associated aneurysms are most often localized to the entire area of vascularization, followed by middle cerebral arteries, posterior cerebral arteries, anterior cerebral arteries and finally the basilar artery (Table 3).
All patients underwent successful surgical resection of the cardiac myxoma. Regarding management strategies, 33 patients (60%) were managed conservatively as the primary choice. In three cases (5.5%) there was chemotherapy treatment; in one case, radiotherapy. One patient was treated with stereotactic radiosurgery.

4. Discussion

Cardiac myxomas are the most common benign cardiac tumor in adults [58]. Myxoma cells most likely arise from resident pluripotent or multipotent mesenchymal stem cells, the embryonic remnants of which differentiate into endothelial cells, smooth muscle cells and other mesenchymal cells and this explains the most common occurrence of myxomas in the atrial septum [58,59]. Myxomas of the heart are most common in adults between the third and sixth decades of life. They can occur sporadically (more often in women) or be familial [1,2,58]. Familial occurrence has been shown to be associated with an autosomal dominant mutation of the PRKAR1A gene located on chromosome 17q2 [59,60]. Familial myxomas are usually multiple, recurrent and located outside the left atrium [61].
The genetic basis of intracranial aneurysms is very complex. In recent years, there has been a growing interest in the extracellular matrix surrounding cerebral vessels, as well as the role of matrix metalloproteinases [62,63]. Studies on the genetics of aneurysms have been aimed at elucidating causative genes or discovering new loci associated with aneurysm risk. Genome-wide association studies have used single nucleotide polymorphism data to discover several susceptibility loci, including the SOX17 and CDKN2A genes. The proteins encoded by these genes regulate endothelial function and blood vessel formation and so genetic variation that affects the extracellular matrix may have the greatest impact on the risk of aneurysms [62,64].
The clinical picture of CM includes symptoms due to embolism, intracardiac obstruction, size, location and mobility of the tumor [1,59]. Patients with small tumors may remain asymptomatic for years, or nonspecific symptoms may mimic systemic or cardiovascular disease [58].
Embolism associated with detachment of tumor fragments or thrombi occurs in 10–50% of patients with cardiac myxomas [59,65]. There has been no correlation between the risk of embolism and tumor size and some authors have suggested an association of such complications with chest trauma [66]. Most commonly, embolisms involve the cerebral arteries, where cavernous malformations and aneurysms can develop. Neurological complications are a very broad group of symptoms that include fainting and loss of consciousness, headache and dizziness, seizures, transient cerebral ischemia, stroke or rupture of aneurysms or vascular malformations [5,8,51]. Women in their fifth decade of life are most at risk for embolic stroke and acute embolic stroke may be the first manifestation of atrial myxoma in a young patient [58,59]. Sudden loss of consciousness after strenuous exercise is particularly important in the patient’s history [58]. Embolism of the coronary artery is rare, and it is even believed that the coronary arteries are relatively resistant to embolism due to anatomical conditions [1,65,67]. Braun et al. [61] showed from their analysis that only 40 cases of myocardial infarction due to myxoma have been documented in the literature.
The etiology of myxomatous cerebral aneurysms is still unknown [40,59]. A few hypotheses have been put forward in terms of the pathogenesis of aneurysms. Based on the literature, two main theories can be identified. First, a neoplastic process theory proposes that myxoma cells adhere to and penetrate the endothelium, then grow in the subintimal layer and destroy the arterial wall. However, it should be remembered that the metastatic hypothesis does not imply a typical tumor metastasis process. By definition, cardiac myxomas are not malignant tumors and therefore do not have potential to “metastasize” in the strict sense of the word. The second theory is the “vascular damage theory” proposed by Sloane et al. in 1966, where the temporary occlusion of cerebral vessels by myxoma cells causes damage to the endothelium, which is followed by an alteration of hemodynamics and promotion of aneurysm formation [68,69,70].
Myxoma cells produce and release proinflammatory cytokine interleukin-6 (IL-6), which is an important factor of aneurysm initiation [18]. Recent studies suggest that autocrine production of IL-6 by myxoma plays a main role in the embolization of the myxomatous cell. Elevated IL-6 levels have been detected in patients with myxomatous aneurysms, before and even after myxoma resection. It has been known that atrial myxoma cells are capable of producing IL-6. Recent studies have shown that there is a connection between overproduction of Il-6 and cerebral aneurysm development. A persistent elevated IL-6 level induces overexpression of multiple proteolytic enzymes (such as metalloproteinase), which can weaken cerebral vessel walls and lead to aneurysm formation [55,71]. Based on this theory, cardiac myxoma resection is usually accompanied by a reduction in serum IL-6 levels, but a few studies have shown new aneurysm formation after the myxoma resection still showed persistently elevated IL-6 levels. Formation of a cerebral aneurysm is also associated with overproduction of Il-6 by an emboli tumor, that induces degradation of the extracellular matrix in the intracranial vessels and is connected with an increased level of IL-6 in cerebrospinal fluid. So, IL-6 has two ways of impacting the formation of the aneurysm’s direction, first by promoting tumor invasion into the intracranial artery or secondly by increasing the chance of a distant embolization of the cardiac myxoma [55,57,71].
The natural history of this kind of aneurysm is also not clear; some cases have shown stability, others have shown improvement (self-occlusion) and others have shown an increased number and enlargement of aneurysms [5,51,57]. In most cases, the first neurological manifestation of atrial myxomas is complications due to cerebral embolism and subsequent cerebral infarction [2,59,65]. Vascular incidents (transient cerebral ischemia, stroke), which were observed in 36.3% of the patients of this review, should be precisely associated with embolism. Aneurysm formation and subsequent subarachnoid or intracerebral hemorrhage are rare but are the most well-known complications of atrial myxoma in adults [5]. Even the presence of multiple but unruptured cerebral vascular aneurysms usually does not produce clinical symptoms. However, up to half of patients with cerebral aneurysms may experience so-called “predictive headaches,” the exact cause of which is not known, but is thought to be related to microbleeding from aneurysms or other vascular malformations [69,72,73]. The other symptoms that were observed in the patients analyzed in this review included seizures, headaches or dizziness that could be related to microbleeding from aneurysms or could be a symptom related to compression of malformations on central nervous system structures. Given some nonspecific but nevertheless quite suggestive clinical signs, it is necessary to screen for cerebral complications in patients with atrial myxoma.
Currently, there are no guidelines for the treatment of aneurysms caused by cardiac myxomas, but a conservative approach and radiological follow-up is recommended. The majority of reported cases have demonstrated stability and some have even been documented as exhibiting spontaneous regression [12]. Routine radiological follow-up by MRI examination is needed to monitor the eventual progression of the aneurysms [72,73]. A lot of therapeutic methods are available, ranging from endovascular methods, surgery, chemotherapy, radiation or a combination of these. Only enlarged or ruptured aneurysms may require invasive management and must be evaluated for endovascular or neurosurgical intervention [4].
The atrial myxoma should be excised as soon as possible after the diagnosis to prevent further complications such as systemic embolization, constitutional symptoms (fever, fatigue, weight loss) or obstruction of the mitral valve [44,58,59]. Surgical resection of the cardiac myxoma also eliminates the early neurologic symptoms, most frequently ischemic cerebral infarcts. Although the cardiac resection of the atrial tumor minimizes the risk of embolization, it does not decrease the risk of the formation of a delayed cerebral aneurysm. This results from the theory of “metastasis and infiltrate”. Intracranial aneurysms may continue to grow despite the surgical removal of the atrial myxoma [53,67].
The current literature describes several different surgical options. Cases of ruptured aneurysms are generally considered as urgent surgical procedures. Clipping or coiling are not applicable for myxomatous aneurysms because they are multiple, located at distal vessels, fusiform and without a neck. The literature provides a few reports about clipping of large aneurysms [54]. Aneurysms might keep growing after endovascular coil embolization [31].
Open surgical treatment is recommended for a lesion-caused mass effect or in cases of single saccular aneurysms. A bypass is recommended for lesions with good collateral compensation and it is a reasonable option when sacrifice of the feeding artery may be required. Compared with other options, this procedure is technically challenging and is limited because it is difficult to apply in a variety of locations where aneurysms may occur [33].
Chemotherapy as a treatment was introduced by Roeltgen et al. in 1981 [74]. They tried doxorubicin in conjunction with surgery for recurrent atrial myxoma. In some cases, etoposide and carboplatin were also used [13,50]. Chemotherapy may protect patients against aneurysm growth [13]. Low-dose radiation in combination with chemotherapy has been reported as an effective method for degradation of metastasis [5,12,13]. A new option is frameless stereotactic radiosurgery (SRT), which is less invasive than endovascular or open surgery, avoids the systemic effects of chemotherapy, and limits toxicity to surrounding brain parenchyma compared to whole brain irradiation [5].

5. Conclusions

Cerebral aneurysms are rare complications of cardiac myxoma, which can appear many years after cardiologic treatment. They are twice as common in middle-aged women. The entire area of vascularization is most often located in the area of the middle cerebral artery. Vascular incidents, unspecific headaches and seizures are their most common clinical manifestations; their rupture and subarachnoid hemorrhages are relatively rare. We do not have any treatment guidelines as yet, however, in the case of myxoma aneurysms a long-term observation is recommended.
Therefore, long-term follow-up of patients with cardiac myxomas for possible co-occurrence of cerebral aneurysms and their complications is very important. In addition, patients with multiple cerebral aneurysms, especially those with a cardiac burden, should be alert to the possibility of cardiac myxoma.

Author Contributions

J.C.-Ł.—conceptualized and wrote the manuscript; S.B.—reviewed the manuscript; M.W.-P.—conceptualized, wrote and reviewed the manuscript. All authors have read and agreed to the published version of the manuscript.


Supported by Wroclaw Medical University.

Institutional Review Board Statement

The study was conducted according to the guidelines of The Declaration of Helsinki, and approved by the Ethics Committee of Wroclaw Medical University.

Informed Consent Statement

Not applicable.

Data Availability Statement

The data presented in this study are available upon request from the corresponding author. The data are not publicly available.

Conflicts of Interest

The authors declare no conflict of interest.


ACAanterior cerebral artery
CTcomputed tomography
CTAcomputed tomography angiography
DSAdigital subtraction angiography
ICAinternal carotid artery
MCAmiddle cerebral artery
MRAmagnetic resonance angiography
MRI magnetic resonance imaging
PCAposterior cerebral artery
PICAposterior inferior cerebellar artery
SWIsusceptibility weighted imaging


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Figure 1. Flow chart of study selection.
Figure 1. Flow chart of study selection.
Jpm 13 00008 g001
Table 1. Overview of cases of cerebral aneurysms in atrial myxoma from the literature.
Table 1. Overview of cases of cerebral aneurysms in atrial myxoma from the literature.
AuthorCaseClinical PresentationAtrial Myxoma HistoryRadiological Findings Cardiological TreatmentAneurysm Procedure
1.Alrohimi et al. [8]37-year-old
thunderclap headache with right-sided ptosisleft atrial myxoma
diagnosed at the same time
CTA—right posterior communicating artery aneurysmopen heart surgeryright posterior communicating aneurysm clipping
2.Asranna et al. [9]57-year-old
secondary generalized seizuresleft atrial
myxoma resection 1 year earlier
DSA—multiple fusiform aneurysms involving the left middle cerebral artery (MCA) M3 segment and angular branchopen heart surgeryconservative
3.Ashalatha et al. [10]54-year-old
left focal motor seizures with secondary generalizationleft atrial myxoma 6 months earlierDSA—multiple, small, distal, fusiform aneurysms along both middle and anterior cerebral arteriesopen heart surgeryconservative
4.Baikoussis et al. [11]72-year-old
vertigo and collapse
with loss of consciousness
left atrial myxoma
diagnosed at the same time
MR—multiple cerebral mycotic aneurysms of various dimensions
and a large cyst, as a result of a previous hemorrhage
open heart surgeryembolization of the large central aneurysms
5.Bernet et al. [12]31-year-old
clonic–tonic seizure
left atrial
myxoma resection 2 months earlier
CT—multiple frontal
and occipital bilateral cerebral aneurysm
open heart surgeryradiation plus chemotherapy
6.Branscheidt et al. [13]41-year-old
‘‘burning’’ headaches and
increasing fatigue
left atrial myxoma
diagnosed at the same time
DSA—multiple fusiform aneurysmsopen heart surgerychemotherapy
7.Chen et al. [14]19-year-old
seizures without loss of consciousnessleft atrial myxoma resection 2 years earlierDSA—many saccular dilations on the distal end of the MCA and PCA of both sidesopen heart surgeryconservative
8.Chow et al. [15]58-year-old
loss of consciousness
2 years earlier SAH (external ventricular
drainage was executed)
left atrial myxoma
without resection
DSA—lobulated aneurysm at the middle cerebral
artery with clipping executed.
open heart surgeryconservative
9Desousa et al. [16]44-year-old
left-sided headache, vomitingleft atrial myxoma resection 8 years earliercarotid angiogram demonstrated progressive narrowing of the left internal carotid artery open heart surgeryconservative
10.Eddleman et al. [17]18-year-old
episode of scintillations in the right visual field lasting 2 h
associated with a headache
left atrial myxoma resection 4 months earlierDSA—multiple fusiform aneurysms the distal anterior,
middle, and posterior circulations
open heart surgeryresection some aneurysm
11.Ezerioha et al. [18]73-year-old
SAHleft atrial myxoma recognized at the same timeCTA 9-mm lobulated aneurysm at the right middle cerebral artery (MCA) trifurcation and a small 3-mm aneurysm at the left MCA bifurcationopen heart surgeryright frontal pterional craniotomy, evaluation of intracerebral hematoma and clipping of the right MCA aneurysm
12.Flores et al. [19]19-year-old
right-sided hemiparesis lasting for one hourleft atrial myxoma recognized at the same timeDSA—multiple fusiform cerebral aneurysms affecting several distal branches of both middle cerebral arteries open heart surgeryconservative
13.Flores et al. [19]61-year-old
acute onset of rotational vertigo and left visual field deficit, stroke 20 years agoleft atrial myxoma recognized at the same timeDSA—multiple fusiform cerebral aneurysms in the left posteroinferior cerebellar artery, two aneurysms in the M2 segment of the right middle cerebral arteryopen heart surgeryconservative
14.Furuya et al. [20]36-year-old
sudden attack of generalized
convulsive seizures
left atrial myxoma resection 1 year earlierDSA—multiple fusiform aneurysms at right operculofrontal,
central, and angular arteries
open heart surgeryresection aneurysms of the angular artery
15.George et al. [21]45-year-old
transient ischemic attackleft atrial myxoma recognized at the same timeDSA—multiple fusiform aneurysm at the right middle cerebral artery aneurysmopen heart surgeryconservative
16.Gupta et al. [22]11-year-old
syncopeleft atrial myxoma resection 1 year earlierCT angiography tortuous, dilated and fusiform left MCA and multiple aneurysms in bilateral MCA and both vertebral arteriesopen heart surgeryconservative
17.Herbst et al. [23]31-year-old mandizziness, nausea, blurred vision of his left eye, and gait
left atrial myxoma was discovered at the same momentDSA—multiple intracranial microaneurysms
in peripheral branches of middle, anterior, and posterior cerebral arteries; a few aneurysms were seen in branches
of the vertebrobasilar arteries
open heart surgeryconservative
18.Hau et al. [5]57-year-old
confusion and memory lossleft atrial myxoma resection 2 years earlierCTA—multiple fusiform intracranial aneurysms at left anterior cerebral artery (ACA) A2 segment bifurcation, right middle cerebral artery (MCA) distal M2 segment, cortical branches at frontal and para-central regions, left posterior cerebral artery (PCA) P3 segment, and right occipital cortical branches, with progressive enlargement half-yearlyopen heart surgerystereotactic radiosurgery
19.Iskandar et al. [24]69-year-old
left arm numbness, weakness, and dysarthrialeft atrial recurrent myxoma resection 20 and 15 years earlierCTA—myxomatous fusiform aneurysms in the right middle and anterior cerebral arteries open heart surgery conservative
20.Ivanovic et al. [25]44-year-old womanten months earlier SAH with operation of left PICA aneurysmleft atrial myxoma ten months earlierDSA—saccular
aneurysm arising from the origin of left posterior inferior cerebelli
open heart surgeryconservative
21.Jean et al. [26]32-year-old
transient ischemic attackleft atrial myxoma resection 5 years earlierDSA—multiple
peripheral, fusiform, intracranial aneurysms
open heart surgeryleft frontal craniotomy for resection of one of the aneurysms located
at the frontal pole
22.Josephson et al. [27]33-year-old
8 years earlier
multiple embolic
left atrial myxoma resection 8 years earlierMRA—multiple fusiform aneurysmsopen heart surgeryconservative
23.Kim et al. [28]58-year-old
right flank pain for several days
20 years earlier three episodes of stroke with dysarthria and right-sides hemiplegia
left atrial myxoma discovered at the same momentMRA—multiple fusiform
aneurysms of the left distal internal carotid artery,
peripheral branch of the right middle cerebral artery, left
posterior cerebral artery, and the distal basilar artery
open heart surgeryconservative
24.Koo et al. [29]64-year-old
dysarthria, generalized weakness, and gait disturbanceleft atrial myxoma discovered at the same momentDSA—multiple fusiform-cerebral aneurysms at distal branches of anterior cerebral arteries (ACA) and middle cerebral arteries (MCA)open heart surgeryconservative
25.Krishnan et al. [30]31-old-year
two episodes of generalized tonic clonic seizuresleft atrial myxoma resection 12 years earlierCTA—fusiform dilation of bilateral distal anterior cerebral arteries, multiple dilations of distal middle cerebral artery branches on both sides and also aneurysmal dilatation of the distal right posterior cerebral arteryopen heart surgeryconservative
26.Lazarow et al. [31]52-year-old manacute right
lower extremity weakness and seizures
left atrial myxoma resection 3 years earlierDSA—diffuse cerebral arterial aneurysmsopen heart surgeryleft MCA branch was
embolized with aneurysm coils
27.Li et al. [32]27-year-old
sudden onset of
vertigo, dysarthria and right-sided weakness
left atrial myxoma recognized at the same timeDSA—multiple typical distal fusiform and saccular aneurysms or aneurysmal dilations
in the bilateral internal carotid artery
open heart surgeryconservative
28.Namura et al. [33] 45-year-old
right hemiparesis 10 years earlierleft atrial myxoma resection after 10 yearsDSA—multiple cerebral aneurysmsopen heart surgeryconservative
29.Oguz et al. [34]40-year-old
numbness in right arm and blurred visionleft atrial myxoma resection 5 years earlierDSA—fusiform dilatations in the prefrontal branch of the right MCA, the angular and frontal branches of the left MCA, and the calcarine branch of the left vertebral arteryopen heart surgeryconservative
30.Oomen et al. [35]40-year-old
sensory loss in tongue and face, and word finding difficultyleft atrial myxoma resection 1 year earlierDSA—micro-aneurysms in the right middle cerebral arteryopen heart surgeryconservative
31.Quan et al. [36]49-year-old
acute headache and dizzinessleft atrial myxoma recognized at the same timeMRA—multiple small aneurysmsopen heart surgeryconservative
32.Penn et al. [37]12-year-old
a sudden headache, diplopia, gait instability, and speech difficultyleft atrial myxoma recognized at the same timeDSA—numerous a
flame-shaped or fusiform dilation on the right internal carotid artery (ICA), a sausage-like fusiform dilation of the right posterior cerebral artery (PCA)
open heart surgery endovascular treatment
33.Radoi et al. [38]45-year-old
headache, nausea, gait disturbances
and weakness of the left extremities
atrial myxoma resection 16 months earlier
DSA—multiple unruptured intracranial microaneurysms,
which were mainly located in the peripheral branches of the
left anterior and middle cerebral arteries
open heart surgeryresection the right parietal lesion
34.Ryou et al. [39]27-year-old
sudden onset dizziness, headache, blurred vision, and tingling
sensations in tongue, arm, and the left side of her face
atrial myxoma on both sides, resection 10 years earlierDSA—revealed multiple fusiform aneurysms in the basilar artery, proximal PICA, left P2 and right P4 segments, temporal branch of the left MCA, and distal branches of the
right MCA and ACA
open heart surgeryconservative
35.Sabolek et al. [40]43-year-old
sudden severe headache, nausea, consciousness disturbancesleft atrial myxoma resection 12 years earlierDSA—fusiform aneurysms of the left anterior cerebral artery, the peripheral branches of the right middle cerebral artery and a giant aneurysm of the basilar arteryopen heart surgeryconservative
36.Saffie et al. [41]37-year-old
photopia and headacheleft atrial myxoma resection
20 months earlier
DSA—left and right PCA aneurysmopen heart surgeryresection/bypass and clipping
37.Santillan et al. [42]68-year-old
transient ischemic attackleft atrial myxoma resection 14 years earlierDSA—multiple, fusiform intracranial
aneurysms in the anterior
and posterior circulation
open heart surgeryconservative
38.Sato et al. [43]64-year-old
right arm weakness and dysarthrialeft atrial myxoma recognized at the same timeDSA- multiple, intracranial
aneurysms in the anterior
and posterior circulation
open heart surgeryconservative
39.Sedat et al. [44]50-year-old
left hemiplegialeft atrial myxoma resection 5 years earlierDSA—multiple fusiform aneurysms on the middle, anterior, and posterior cerebral arteriesopen heart surgeryradiation
40.Sorenson et al. [45]53-year-old
subacute aphasia and hemiparesisleft atrial myxoma resection 5 years earlierDSA—multiple intracranial aneurysms, giant fusiform aneurysm of the left middle cerebral arteryopen heart surgerycoil embolization
41.Sriwastara et al. [46]30-year-old
severe right sided
headache, weakness of left upper and lower
limbs and deviation of angle of mouth to
right side with slurring of speech
left atrial myxoma recognized at the same timeCTA saccular aneurysm arising from M2 segment
of right MCA
open heart surgerycerebral aneurysm clipping
42.Stock et al. [47]22-year-old
noneleft atrial myxoma resection
11 years earlier
DSA—aneurysms in both middle cerebral arteries (MCA) and right anterior cerebral artery (ACA)open heart surgeryconservative
43.Sveinsson et al. [48]19-year-old
episodic loss of consciousness and right-sided weaknessleft atrial myxoma recognized at the same timeDSA—large number of distal well-demarcated fusiform aneurysmsopen heart surgeryconservative
44.Tamuleviciute et al. [49]29-year-old
TIA-like symptomsleft atrial myxoma resection
12 years earlier
DSA—multiple small and fusiform distal aneurysmsopen heart surgeryconservative
45.Vontobel et al. [50]41-year-old womandizzinessleft atrial myxoma recognized at the same timeMRA—multiple fusiform aneurysmsopen heart surgerychemotherapy
46.Waliszewska-Prosół et al. [51]62-year-old womanvertigo, tinnitus, headacheleft atrial
myxoma resection 12 years earlier
DSA—multiple fusiform aneurysms located on
peripheral branches of middle (MCA), anterior (ACA), and posterior (PCA) cerebral arteries
open heart surgery conservative
47.Waliszewska-Prosół et al. [51]48-year-old mana first generalized
seizure due to intracranial parenchymal bleeding
left atrial
myxoma resection 6 years earlier
SWI—area of intracranial bleeding in the left parietal
lobe from a ruptured aneurysm;
DSA—multiple fusiform
aneurysms located on peripheral branches of the middle, anterior, and posterior cerebral arteries
open heart surgeryconservative
48.Walker et al. [52]60-year-old
two week history
of progressive occipital headache, intermittent
visual changes, right facial pain, and
left atrial myxoma resection 6 years earlierDSA—large irregular
fusiform aneurysms of the proximal SCA bilaterally and a peripheral
fusiform aneurysm of a distal posterior right
middle cerebral artery branch
open heart surgerya right pterional craniotomy was undertaken but any component of the aneurysm
was suitable for clipping
49.Wan et al. [3]39-year-old
headache associated with
blurred vision
left atrial myxoma resection 1 years earlierMRA—multiple aneurysms on the bilateral anterior cerebral artery, middle cerebral artery, right posterior cerebral artery and superior cerebellar arteryopen heart surgeryclipping of the left ACA arterial aneurysm
50.Xie et al. [6]41-year-old
abnormal behavior and logorrhealeft atrial myxoma recognized at the same timeCTA—large number of cerebral aneurysms
mostly on the distal branches of both sides of middle and anterior cerebral artery
open heart surgeryconservative
51.Xu et al. [53]46-year-old
sudden anesthesia of right upper limb,
paroxysmal headache for three months
left atrial myxoma resection 3 years earlierDSA—multiple fusiform cerebral aneurysms mostly on the middle and some on anterior arteryopen heart surgeryconservative
52.Yilmaz et al. [54]38-year-old
headache, episodes of right sided weaknessleft atrial myxoma resection 25 years earlierDSA—multiple fusiform aneurysms on both carotid artery territories, one of which was a giant aneurysm on the left MCAopen heart surgerycoil embolization of the giant aneurysm
53.Yoo et al. [55]20-year-old
without symptoms,4 years earlier transient left side motor weakness left atrial myxoma recognized at the same timeDSA—multiple fusiform cerebral aneurysms, a right MCA fusiform aneurysm was the largestopen heart surgeryM2-M2 bypass surgery
54.Zeng et al. [56]60-year-old
blunt headache since 2 daysleft atrial myxoma resection 2 years earlierCTA—multiple fusiform aneurysmopen heart surgeryaneurysm was clipped after thrombus dislodgement
and angioplasty
55.Zhang et al. [57]38-year-old
10 days history dizziness and headacheleft atrial myxoma and aneurysm recognized at the same timeCTA—two fusiform aneurysms on the left anterior cerebral artery and left posterior
cerebral artery
open heart surgeryconservative
CTA—computed tomography angiography; DSA—digital subtraction angiography; MRI—magnetic resonance imaging; CT—computed tomography; MRA—magnetic resonance angiography; SWI—susceptibility weighted imaging; MCA—middle cerebral artery; PICA—posterior inferior cerebellar artery; ICA—internal carotid artery; PCA—posterior cerebral artery; ACA—anterior cerebral artery.
Table 2. The most common clinical symptoms.
Table 2. The most common clinical symptoms.
Clinical Presentationn (%)Women:MenMean Age
vascular incidents20 (36.3)12:8 44.5
headache15 (27.3)11:440.2
seizures9 (16.4)3:637.6
vertigo/dizziness8 (14.5)6:240.1
loss of consciousness4 (7.3)4:048
subarachnoid hemorrhage 3 (5.5)3:058.3
no symptoms 2 (3.6)--
Table 3. Location of brain aneurysm.
Table 3. Location of brain aneurysm.
multiple—the entire area of vascularization1731.1
MCA + ACA712.7
MCA + PCA59.1
ACA + PCA35.5
MCA—middle cerebral artery; PCA—posterior cerebral artery; ACA—anterior cerebral artery; BA—basilar artery.
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Chojdak-Łukasiewicz, J.; Budrewicz, S.; Waliszewska-Prosół, M. Cerebral Aneurysms Caused by Atrial Myxoma—A Systematic Review of the Literature. J. Pers. Med. 2023, 13, 8.

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Chojdak-Łukasiewicz J, Budrewicz S, Waliszewska-Prosół M. Cerebral Aneurysms Caused by Atrial Myxoma—A Systematic Review of the Literature. Journal of Personalized Medicine. 2023; 13(1):8.

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Chojdak-Łukasiewicz, Justyna, Sławomir Budrewicz, and Marta Waliszewska-Prosół. 2023. "Cerebral Aneurysms Caused by Atrial Myxoma—A Systematic Review of the Literature" Journal of Personalized Medicine 13, no. 1: 8.

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