This case highlights the importance of thorough workup including cardiac imaging (TEE) and brain MRI for suspected cerebrovascular events when initial CT is normal.
Recurrent multifocal emboli merit TEE despite negative initial workup; single case leaves open need for prospective diagnostic algorithms.
A woman in her early 60s presented with multiple transient neurological symptoms over the course of 20 months, including transient loss of power to her right lower limb. Initial workup with CT brain scan, carotid dopplers and ECG revealed no abnormality; however, MRI of the brain suggested recent ischaemic events in separate cortical territories. Subsequent transoesophageal echocardiogram revealed a large mobile mass histologically confirmed to be an atrial myxoma. This case highlights the challenges in diagnosing atrial myxomas and the importance of thorough workup including cardiac imaging for suspected cerebrovascular events. It also underscores the role of brain MRI when clinical suspicion for a cerebrovascular event persists despite a normal CT scan.
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Devlin et al. (2025) studied this question.
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