A case of embolic stroke from atrial myxoma

Cardiac myxoma is the most common benign cardiac tumor and one of the most frequent onset symptoms are neurological.1 A 54-year-old male suffering of hyperthension and dislipidemia was admitted by ambulance to the emergency department after an acute neurological attack (aphasia, left gaze deviation, anisocoria, diaphoresis).Due to clinical worsening up to GCS 4, he was intubated and mechanically ventilated.A head CT-scan (Figure 1) was negative for cerebral hemorrhage and brain tumors, a neck ultrasound scan showed no carotid stenosis or dissection of the neck vessels.In the suspection of cerebral ischemia, systemic trombolysis was started.Due to technical problems, angio CT-scan (Figure 2) was performed 1 hour later and a sphenoidal segment (M1) left middle cerebral stenosis was found; accidentally an atrial disomogeneous mass was discovered (Figure 3).No intra-aortic trombolysis or tromboaspiration was performed by interventional radiologist summoned at the end of alteplase infusion.No indication for craniothomy wase made by neurosurgeons.Transesophageal echocardiography (Figure 4) confirmed a large, peduncolated disomogeneous mass occuping the entire left atrium, with extremities reaching the mitral valve plane, with signs of obstruction.He was electively scheduled for resection 4 weeks after the start of symptoms, when the risk of a catastrophic neurologic event from anticoagulation during cardiopulmonary bypass (due to the potential for hemorrhagic conversion) was considered to be reduced.2,3 The patient was discharged on 35 th day and he has a good recovery.