Primary cardiac tumors are exceedingly rare, with an estimated incidence of approximately 0.02%. Fibroelastomas is the second most common primary cardiac. It can result in severe complications such as ischemic stroke, transient ischemic attack (TIA), or systemic embolization. Definitive diagnosis is established through histopathological examination of the excised specimen. Surgical excision remains the curative treatment of choice and should be performed promptly to minimize the risk of recurrent embolic events. 

62-year-old woman with a history of hypertension and coronary artery disease who presented with acute slurred speech and left-sided weakness. Computed tomography (CT) of the head demonstrated loss of gray–white matter differentiation over the right sylvian fissure. CT angiography of the head and neck revealed no large vessel occlusion. Magnetic resonance imaging (MRI) of the brain showed an acute infarct in the right external capsule. Telemetry monitoring in hospital was unremarkable for any arrythmias. Transthoracic echocardiography (TTE) revealed a left ventricular ejection fraction of 30%. Transesophageal echocardiography (TEE) revealed 1-cm mobile mass attached to the aortic valve along the left coronary cusp, suggestive of a fibroelastoma.  Two sets of Blood cultures were negative. Following cardiothoracic surgical evaluation, the patient underwent surgical excision of the aortic mass under cardiopulmonary bypass. Histopathological examination confirmed fibro-myxoid degeneration consistent with fibroelastoma.

Fibroelastomas are a rare but important cause of cardioembolic stroke. Early recognition is critical to prevent significant risk of morbidity and mortality due to recurrent embolization. While TTE serves as an initial screening tool in stroke evaluation, TEE or cardiac magnetic resonance imaging should be pursued when suspicion for a cardiac source of embolism remains high. Surgical excision remains the gold-standard treatment. The role of long-term oral anticoagulation in patients who are not surgical candidates remains uncertain and warrants further investigation.