A 26-year-old female presenting with a fatal stroke due to embolism of Cardiac Myxomatous Neoplasm diagnosed at a Kenyan forensic autopsy service: a case report

Abstract

Introduction: Cardiac myxomas are rare intracardiac neoplasms that frequently embolize resulting in cerebral infarcts (strokes). These appear to affect youthful women and may occur in the peripartum period. They are rare causes of maternal mortality and may present as sudden unexpected death. Because of this, their diagnosis may be made through forensic autopsies and may confound homicide investigations. Because histopathology are rarely performed in African forensic autopsies, these diagnoses are frequently missed. Case Report: We present a case of a 26-year-old female who had a sudden and unexpected death resulting from a stroke due to embolization of a cardiac myxoma. She had delivered a live newborn six weeks earlier. Prior to this, she had recurrent undiagnosed transient ischemic attacks, which were never investigated. On the day of her death, she had an argument with her spouse, one hour later, she was found unable to talk, move and with right sided weakness. She was then taken to hospital where she succumbed 12 hours later. The spouse was arrested, and a murder investigation commenced. The autopsy was performed 72 hours after her death, the main findings were tumor emboli to the cerebral arteries and an atrial myxoma, there was no evidence of external trauma. The cause of death was attributed to the atrial myxoma and emboli. Because of the natural manner of death, the accused person was acquitted. Conclusion: Cardiac myxoma embolization with cerebral infarction is a rare cause of maternal mortality. Their prevention may require increased surveillance and improved clinical workup for young person with risk factors for stroke. With increased index of suspicion, these should be sought in sudden deaths occurring among young people. While forensic pathologists in Africa rarely perform histopathology, detailed pathological evaluation in these circumstances are essential. Keywords: Peripartum stroke, atrial myxoma, maternal mortality, forensic autopsy