The One Percent Stroke: A Case Report

Cardiac myxoma (CM) is the most prevalent form of benign primary tumor of the heart, but it is a rare cause of stroke, accounting for less than 1% of strokes in the general population. CM has a heterogeneous clinical presentation that can frequently resemble other cardiovascular or neurological disorders. This diminutive differential will often impede timely diagnosis. We describe a 42-year-old woman who presented with right-sided hemiparesis and aphasia of sudden onset. Neuroimaging findings were significant for multiple acute non-hemorrhagic infarcts on the left side of the brain, possibly suggesting an embolic source. Echocardiography findings were compatible with a left atrial myxoma. The patient subsequently developed central retinal vein occlusion (CRVO) in the left eye. The patient was provided with medical and supportive care to include anticoagulation, and she underwent successful resection/excision of the left atrial myxoma, which subsequently led to a partial neurological recovery. This case highlights important considerations for cardiac sources of embolic strokes in young patients who do not have more traditional vascular risk factors. Rapid use of echocardiography to identify rare but treatable causes like CM should be considered. Successful surgical management of CM represents an effective approach. Failure to complete successful surgical management raises the risk of further side effects from other occult sources of emboli. CM should be a consideration in the differential diagnosis of embolic strokes in young adults, even if it is a rare etiology. Timely multimodal imaging, combined with proactive clinical efforts, should result in better patient outcomes.