Global Transient Amnesia as the Predominant Symptom of Cardiac Myxoma: A Case Report.

BACKGROUND The most common neurological symptoms from cardiac myxoma-induced stroke include territories of middle cerebral arteries, rendering posterior stroke less common. Although transient global amnesia usually has a benign prognosis, amnesia in the setting of concerning cerebellar symptoms should raise the suspicion for posterior circulation involvement. These benign-appearing symptoms can be manifestations of an acute cerebrovascular accident (CVA). This unusual presentation can delay workup for underlying pathology. CASE REPORT A 67-year-old woman presented to the local emergency department after an episode of global amnesia that lasted about 15 minutes and was associated with some dizziness. The patient also reported a history of chronic disequilibrium. The head CT scan was negative for any acute findings. A follow-up MRI of the brain demonstrated acute small lacunar infarcts within the left cerebellum and right parietal lobe. An echocardiogram was performed due to concern for the cardioembolic source, which revealed left atrial myxoma. She was transferred to a tertiary center for immediate surgical intervention due to the high risk of embolization associated with the condition. The patient subsequently underwent successful surgical excision of the lesion. CONCLUSIONS Cardiac myxoma, although a rare cause of posterior stroke, needs prompt intervention as it is associated with a high risk of systemic embolization, including recurrent CVA. Transient global amnesia is an atypical presentation of cardiac myxoma that can easily be overlooked, delaying timely diagnosis and prompt intervention. Early recognition and surgical resection are crucial to prevent potentially life-threatening consequences.

A Case of Suspected Statin-Related Delayed Onset Necrotizing Myositis.

Statin-induced necrotizing myositis is a rare subtype of idiopathic inflammatory myopathies due to the production of an antibody to the 200/100 kDA protein complex which was subsequently found to be directed against 3-hydroxy-3-methylglutaryl coenzyme A reductase (HMGCR). Similar to other auto-immune necrotizing myopathies, the disease is characterized by proximal muscle weakness, significant serum creatine kinase elevations, and histological evidence of necrosis of myocytes. However, there is often little to no infiltration of inflammatory cells noted on muscle biopsy. As the name implies, this subtype of idiopathic inflammatory myopathy is provoked by statin use which may be a helpful finding during the history-taking process when developing a differential diagnosis. Below, we discuss a case of a 52-year-old female with delayed-onset immune-mediated necrotizing myopathy secondary to statin use.

Correction: A Case of Suspected Statin-Related Delayed Onset Necrotizing Myositis.

[This corrects the article DOI: 10.7759/cureus.22893.].

Clot in Transit: Therapy via Peripherally Inserted Central Catheter Line.

There are currently no definitive guidelines for the optimal management of clots in transit (CIT) due to a distinct lack of quality research to suggest a recommended therapy. The three main treatment modalities that are commonly utilized for pulmonary emboli (PE) (a sequela of CIT) are thrombolysis, pulmonary embolectomy, and anticoagulation alone. The current recommendation for severe PE with hemodynamic collapse is to consult cardiothoracic surgery for clot retrieval. One ongoing area of research involves the use of catheter-directed application of thrombolytic agents as it may have similar outcomes to the systemic application while minimizing the risk of bleeding events due to a lower dose of medication used. We report the case of a patient in whom, by taking advantage of an already placed peripherally inserted central catheter (PICC) line, tissue plasminogen activator (tPA) was successfully delivered at a localized site near the clot for active thrombolysis while only causing minimal adverse effects related to recent laminectomy/fasciectomy and foraminotomy compared to what may have been observed with systemic tPA administration.

Prolonged Use of an Impella Assist Device in a Sepsis-Induced Cardiomyopathy: A Case Report.

The inflammatory response triggered by sepsis can frequently cause reversible myocardial depression termed sepsis-induced cardiomyopathy. The resulting pathologic changes are often self-limiting and cardiac function returns to baseline following resolution of the underlying exacerbating factors. The following case examines a patient with septic shock and sepsis-induced cardiomyopathy that, despite maximal medical therapy, required mechanical support with an Impella assist device for seven days. To the best of our knowledge and research, this represents the longest documented use of an Impella heart pump in septic shock and associated sepsis-induced cardiomyopathy. Utilization of mechanical support in the setting of septic shock has seen growing interest in recent years, but more structured studies need to be conducted for better understanding of their overall effect on morbidity and mortality.