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Images in Neurology
June 22, 2020

Spinal Cord Infarction and Metastasis Attributable to Atrial Myxoma

Author Affiliations
  • 1Department of Neurology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
  • 2Department of Neurosurgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
JAMA Neurol. Published online June 22, 2020. doi:10.1001/jamaneurol.2020.1495

A 47-year-old, previously healthy man presented with acute-onset severe lower back pain followed by weakness of bilateral lower limbs. He could not move his legs after 30 minutes after onset. There was neither a history of trauma nor preceding infection. A neurological examination revealed muscle power in both lower limbs was at grade 0, but power was normal in upper limbs. The absence of pain and temperature sensation was noted below the T10 level. Laboratory tests, including hematologic and biochemical analyses, had normal results. Serum anti-aquaporin–4 (AQP4) antibody tests through cell-based assays had negative results. An ultrasonic cardiogram showed a pedunculated mass in the left atrium. The first magnetic resonance image (MRI) of the spine was performed 6 hours after the onset of symptoms and showed no obvious abnormalities. A second MRI performed 72 hours after the onset of symptoms revealed hyperintense lesions extending from T9 to T10 (Figure 1). The sudden onset of severe paraplegia with back pain, lumbar MRI changes, and normal cerebrospinal fluid findings supported the diagnosis of a spinal cord infarction. Then, the patient was treated with anticoagulant and antiplatelet agents for 5 months. A surgical procedure was performed, and myxoma was pathologically confirmed. At 15 months after cardiac surgery, muscle power in both lower limbs were still at grade 0; numbness and tingling of both lower extremities was gradually aggravated. A spinal MRI revealed an enhanced nodular lesion compressing the adjacent spinal cord in the subarachnoid space at the level of T10 (Figure 2A). He then underwent a second operation, during which the atrophy of the spinal cord and a mass attached to the surface of an aneurysmlike dilated anterior spinal artery were found. Histopathologic examination showed myxomatous tissue outside the blood vessels and myxomatous proliferation inside the vascular lumen (Figure 2B). After 5 months after the spinal operation, numbness and tingling of both legs improved, but his legs were still unable to move.

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