Submited on: 10 Mar 2011 01:10:02 PM GMT
Published on: 11 Mar 2011 10:25:18 PM GMT
 
Myxoma Presenting as Cerebral Sichemia.
Posted by Dr. Nikolaos Kakouros on 21 Feb 2013 06:12:31 PM GMT

  • What are the main claims of the paper and how important are they?

    The authors describe  the case of an elderly patient who presented with acute cerebral ischemia and was found to have a large atrial myxoma that was successfuly surgically excised.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    The presentation is not novel but a helpful reminder of this rare condition.


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Using Occam's razor the myxoma does appear as a smoking gun for the CVA here. Although additional investigation for embolic sources (e.g. carotid Dupplex) may be warranted I do not think that specific investigation for an PFO is necessarily warranted, particularly given the high incidence of this finding in the general population.


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    NA


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    NA


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    NA


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    The paper is overall well written. There are some orthographical errros. I agree with a previous reviewer that the author names for referenced reviews need not appear in the text.


  • Other Comments:

    As discussed in previous reviews, this case report raises the question of the value of cardiac imaging in the investigation of potential sources in a patient presenting with acute cerebral ischemia of posslb embolic etiology.

     

    There is general agreement that cardiac imaging can detect potential sources of emboli that may lead to cahnges in management (e.g. anticoagulation, or surgical excision as in this case!). Over the last few years, there have also been studies suggesting that upfront TEE is diagnostically superior to routine TTE to pick up such abnormalities in this patient group.

     

    e.g. Wolterbeek, Eduard R. Holman, Edward L.E.M. Bollen and Jeroen J. Bax
    Sebastiaan F.T.M. de Bruijn, Willem R.P. Agema, Gert Jan Lammers, Ernst E. van der Wall, Management of Patients of Any Age With Transient Ischemic Attack or Stroke
    Transesophageal Echocardiography Is Superior to Transthoracic Echocardiography

    doi: 10.1161/01.STR.0000241064.46659.69

  • Competing interests:
    None
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:

    Kakouros N, McWilliams E, Giles J. Left atrial myxoma. J Cardiovasc Comput Tomogr. 2008 May-Jun;2(3):188-90.

  • Experience and credentials in the specific area of science:
    None
  • How to cite:  Kakouros N .Myxoma Presenting as Cerebral Sichemia.[Review of the article 'An Unusual Cause of Cerebral Ischemia in the Elderly: Left Atrial Myxoma ' by Romeo R].WebmedCentral 2011;4(2):WMCRW002528
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1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? No
3 Is this a new and original contribution? No
4 Does this paper exemplify an awareness of other research on the topic? No
5 Are structure and length satisfactory? No
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? Yes
7 Can you suggest any reductions in the paper, or deletions of parts? No
8 Is the quality of the diction satisfactory? No
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? No
11 Are the keywords and abstract or summary informative? No
  • Other Comments:

    I think this paper is only a case report and it is not written in a scientific manner. The authors present in the abstract a review of myxomas and do not introduce the subject to be presented.

    Apart from this the case report is not written in a proper scientific way and leads the reader to a bad judgment of the case.

    The authors say that this sign of cerebral ischemia occurs associated with myxomas in the elderly. I strongly disagree as we know that it can occur in any age, and there are a few reports of cerebral ischemia in lower ages. Another point is that the ischemia, could also have been a manifestation of a Patent Foramen Ovalis, which is common in elderly patients.

    On the other hand, we agree, that any patient with these symptoms should be screened, by means of echo transthoracic or transesophageal to see for any mass in the cavities or a PFO

  • Competing interests:
    No
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    Yes
  • References:
    Tratamento Cirúrgico de Mixomas do Átrio Esquerdo. Almeida RMS, Kahrbek T, Lima Jr JD, Loures DR Revista Paranaense Cardiologia 2000;1:32-34.
  • Experience and credentials in the specific area of science:

    Paper published in a national journal, presenting our experience in myxoma

  • How to cite:  Almeida R M.An Unusual Cause of Cerebral Ischemia in the Elderly: Left Atrial Myxoma [Review of the article 'An Unusual Cause of Cerebral Ischemia in the Elderly: Left Atrial Myxoma ' by Romeo R].WebmedCentral 2011;2(12):WMCRW001261
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1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? Yes
3 Is this a new and original contribution? No
4 Does this paper exemplify an awareness of other research on the topic? Yes
5 Are structure and length satisfactory? Yes
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? Yes
7 Can you suggest any reductions in the paper, or deletions of parts? No
8 Is the quality of the diction satisfactory? Yes
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? Yes
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    The article presented a case of neurological manifestation of cardiac myxoma. Myxoma is the most common primary tumor of the heart in adults. Myxomas are typically pedunculated, with a stalk that is attached to the interatrial septum.

    The authors may have a discussion on the differential diagnosis of cardiac tumors, and the way to diagnose them clinically.

    As stated above this case is not so rare, but it is good to be reminded occasionally. The article was written very well. Just the authors did not need to mention the authors of studies when they want to refer to them. They can just refer to them in numerical format (e.g. [2]).

    I agree with the conclusion of the authors that in elderly presented by CVA, cardiologic examination and transthoracic echocardiogram is necessary to rule out a cardiac problem including myxoma.

  • Competing interests:
    No Competing Interest.
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I performed a literature review in this case, but not experienced such a patient in my practice...

  • How to cite:  Sepehrvand N .Cardiologic evaluation for the elderly patients with cerebral ischemia[Review of the article 'An Unusual Cause of Cerebral Ischemia in the Elderly: Left Atrial Myxoma ' by Romeo R].WebmedCentral 2011;2(6):WMCRW00838
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1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? Yes
3 Is this a new and original contribution? Yes
4 Does this paper exemplify an awareness of other research on the topic? No
5 Are structure and length satisfactory? Yes
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? No
7 Can you suggest any reductions in the paper, or deletions of parts? No
8 Is the quality of the diction satisfactory? Yes
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? Yes
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    My opinin is that a cardiologic examination and  echocardiography are necessary in the evaluation of the elderly population revealing clinical conditions due to cardiac diseases even in case of particular sympotms as the neurologic disease.

  • Competing interests:
    none
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    In my practise in emergency unit care I found different cases of cerebral ischemia related to cardiac embolism

  • How to cite:  Giannotta D .An unusual cause of cerebral ischemia in the elderly: left atrial myxoma[Review of the article 'An Unusual Cause of Cerebral Ischemia in the Elderly: Left Atrial Myxoma ' by Romeo R].WebmedCentral 2011;2(4):WMCRW00672
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