Thrombectomy for Pediatric Stroke Due to Myxoma Embolism

Introduction: Stroke presentation secondary to a cardiac myxoma thromboembolism are rare in the pediatric population. Reported cases in the literature are mainly case reports. Additionally, pediatric stroke management lacks evidence-based guidelines because of its low incidence and lack of clinical trials. In pediatric strokes identified from a cardiac myxoma, the incidence favors boys with classical presentation of unilateral weakness and aphasia.

Methods: We performed a systematic review by searching PubMed, Google Scholar, Web of Science, and Embase databases for cases of pediatric myxoma causing stroke (n=2431).

Results: Nineteen patients between the ages 4-16 years who underwent surgical treatment due to cardiac myxoma were included in the systematic review. The median age was 11 years. Female pediatric patients represented 31.6% (6/19) of the population, whereas 68.4% (13/19) were male. The singular study design was case report (100%). MRI was used in 8 cases preoperatively for diagnostic purposes (42%), CT was used in 7 cases (36.8%), CTA In 6 cases (31.6%), echocardiogram in 5 cases (26.3%), and MRA in 3 cases (15.8%). 36.8% of patients underwent a mechanical thrombectomy or embolectomy for treatment of the intracranial embolus and 63.2% of patients underwent a cardiac surgery for resection of the source cardiac myxoma. Of the included cardiac myxomas, pediatric patients presented with unilateral weakness in 16 cases (84%). Aphasia was present in 36.8% (7/19) of reported cases, gaze abnormalities in 31.6% (6/19), skin changes (e.g., rash, purpuric macules, blanching lesions, spotty skin pigmentation) in 31.6% (6/19), murmur in 21.1% (4/19), and seizure in 15.8% (3/19).

Conclusion : It is critical for providers to have an in-depth understanding and awareness of the clinical presentation of acute ischemic pediatric stroke to facilitate timely diagnosis and treatment. Further research is needed to provide evidence-based guidelines for the general management of pediatric strokes. As our understanding of the role of thrombectomy in pediatric patients continues to evolve, it is becoming increasingly evident that each case requires careful consideration and age alone should not be the determining factor in withholding treatment.