title: A case of large atrial myxoma presenting as an acute stroke.
abstract: Left atrial myxomas are rare primary cardiac tumors. Their incidence is estimated to be about 0.1% of total cases. Neurological complications resulting from cardiac myxomas are seen in 20-35% of patients. Transesophageal echocardiogram (TEE) is preferred over transthoracic echocardiogram for evaluation of left atrial myxoma. Three-dimensional (3D) echocardiography ensures better visualization of intracardiac structures. It has been used prior to surgery for diagnostic support in the surgical treatment of cardiac masses. We present a case of a 46-year-old Hispanic male who developed acute ischemic stroke of left frontal lobe and was also found to have multiple 'silent' cerebral infarcts in the MRI of the brain. On further workup, he was found to have a left atrial myxoma on 3D TEE. This was resected with the assistance of intra-operative 3D TEE imaging. We present this case to increase awareness and to stress at early evaluation of secondary causes of ischemic cerebrovascular accident, outside the realm of hypercoagulability. This case also exhibits the need for basic cardiac workup in young individuals who present with symptoms of intermittent palpitations or chest pain to minimize significant morbidity or mortality.
authors.affiliation: Department of Internal Medicine, Seton Hall University of Health and Medical Science at St Francis Medical Center, Trenton, NJ, USA; iyerpraneet@yahoo.com.
authors.forename: Praneet
authors.initials: P
authors.lastname: Iyer
authors.affiliation: Department of Internal Medicine, Seton Hall University of Health and Medical Science at St Francis Medical Center, Trenton, NJ, USA.
authors.forename: Myo Myo
authors.initials: MM
authors.lastname: Aung
authors.affiliation: Department of Internal Medicine, Seton Hall University of Health and Medical Science at St Francis Medical Center, Trenton, NJ, USA.
authors.forename: Muhammad Umer
authors.initials: MU
authors.lastname: Awan
authors.affiliation: Department of Neurology, St. Francis Medical Center, Trenton, NJ, USA.
authors.forename: Charles
authors.initials: C
authors.lastname: Kososky
authors.affiliation: Department of Cardiology, St Francis Medical Center, Trenton, NJ, USA.|Mercer Bucks Cardiology Group, Robbinsville, NJ, USA.
authors.forename: Kulpreet
authors.initials: K
authors.lastname: Barn
keywords: acute stroke; left atrial myxoma; three-dimensional transesophageal echocardiogram