Objective:

NA

Background:

Cardiac myxomas account for up to 50% of all primary cardiac tumors and predominantly involve the left atrium in up to 75% of cases. Although benign, their critical location within the heart and friability can lead to serious complications including intracardiac obstruction, thrombus formation, and embolization of tumor fragments leading to acute ischemic stroke.

Design/Methods:

NA

Results:

We describe a case of a 40-year-old female with no significant past medical history who presented with sudden onset of right upper and lower extremity weakness and sensory loss. She experienced an unintentional 14 pound weight loss over the past 8 months. Initial vitals were notable for a blood pressure of 165/97 mmHg and temperature of 37.8°C. Neurologic exam was notable for 4/5 right upper extremity strength with decreased sensation over her right upper and lower extremity. Initial workup including a CT head and CT angiogram of the head and neck were without acute findings. Intravenous Tenecteplase was administered. Subsequent MRI brain revealed dozens of punctate to sub-centimeter acute ischemic infarcts within the anterior and posterior circulation of the left cerebral hemisphere. A transthoracic echocardiogram showed a mobile, pedunculated mass within the left atrium which was subsequently confirmed with transesophageal echocardiography. The patient underwent urgent open-heart surgery where a friable myxoma was removed in several pieces. The patient was discharged on hospital day 9 with resolution of her weakness and hemianesthesia. 

Conclusions:

Our case highlights the importance of maintaining a high index of suspicion for non-thrombotic etiologies in young patients presenting with ischemic stroke. Early cardiac imaging is critical, as prompt identification and surgical resection of cardiac myxomas remain the only definitive treatment to prevent recurrent cardioembolic events.