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.