Presentation of case
We describe the case of a 48years old south Asian gentleman presenting to the emergency department with complaints of sudden onset of slurring of speech, episodes of vomiting and complete motor aphasia for last ten hours which started improving slowly over the last one hour. The patient had similar complaints 5 months back which resolved completely in a few hours, so the patient did not seek any medical advice. He had no history of hypertension or diabetes mellitus. On physical examination, the patient was afebrile. His blood pressure was 106/74mmHg with a heart rate of 104 beats/minute and all distal pulses were felt. On cardiac examination, heart rhythm was regular and a faint, short mid-diastolic murmur was heard. Neurologically, there was motor aphasia with no peripheral neurological deficit. Computed tomography (CT) scan of the brain showed multiple infarcts in left parietal lobe, right occipital lobe, right body of caudate nucleus, left internal capsule, left thalamus and bilateral cerebellar hemispheres. Magnetic resonance imaging (MRI) of the brain depicted multiple foci of high signal on diffusion weighted imaging (DWI) in right corona radiata, left thalamus, and bilateral cerebellar hemispheres making a diagnosis of infarcts (figure 1). These multiple bilateral infarcts were suggestive of cardio-embolic origin. However, the patient had no past relevant cardiac history.
Cardiac workup was done immediately. Electrocardiogram of the heart showed normal sinus rhythm with left atrial enlargement. Two dimensional echocardiogram was performed which revealed a 39×20 mm large homogeneous mass in the left atrium attached to the interatrial septum which was mobile and protruding into the left ventricle (figure 2). The appearance was suggestive of a left atrial myxoma. In view of cardio-embolic stroke, he underwent surgical excision of the mass (figure 3). Biopsy report confirmed it to be a myxoma. He consequently recovered his normal speech and was discharged in a stable condition.