Atrial myxoma and ischaemic stroke

A 46-year-old woman presented with a 6-h history of dizziness and ataxic gait. She had no notable medical history. On arrival, her vital signs were normal. Examination revealed a Levine grade II/VI diastolic murmur at the apex, impaired finger-to-nose and heel-to-shin testing on the left side, and a National Institutes of Health Stroke Scale score of 2. Laboratory studies revealed elevated D-dimer levels, and electrocardiography demonstrated a sinus rhythm. Magnetic resonance imaging revealed acute infarcts in the right thalamus (Figure 1A) and left cerebellum (Figure 1B). Transthoracic echocardiography identified a 6.5 × 5.0 cm multilobulated, mobile mass with a stalk attached to the interatrial septum (Figure 1C). It was prolapsing into the left ventricle in diastole and causing mild mitral stenosis. We diagnosed cardioembolic stroke secondary to a cardiac mass. Surgical excision was performed, and histopathological examination confirmed the diagnosis of cardiac myxoma. The patient was discharged without neurological deficits.