Ultrasound-Assisted Diagnosis of Embolic Cerebrovascular Accident From Left Atrial Myxoma in the Emergency Department



      Acute-onset, unilateral weakness is an alarming presentation due to the possibility of a cerebrovascular accident. When considering cerebrovascular accidents in patients younger than 35 years, emergency physicians should evaluate embolic sources.

      Case Report

      A 28-year-old man with no reported past medical history presented to the Emergency Department with a complaint of acute-onset left-sided hemiparesis and facial droop that started a day prior to arrival. He was stable, had unilateral weakness, hyperreflexia, and slightly slurred speech. He reported no sensory deficits. A computed tomography scan of the head demonstrated areas of ischemia. Patient demographics suggested an embolic source, so point-of-care-ultrasound (POCUS) was performed by emergency practitioners, leading to the discovery of a large, mobile, left atrial mass. After admission and confirmatory imaging, the mass was surgically removed.

      Why Should an Emergency Physician Be Aware of This?

      In young, otherwise healthy individuals, heart masses should be considered as a cause of unexplained stroke-like symptoms. POCUS can identify these masses and expedite care.


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        • van Alebeek ME
        • Arntz RM
        • Ekker MS
        • et al.
        Risk factors and mechanisms of stroke in young adults: the FUTURE study.
        J Cereb Blood Flow Metab. 2018; 38: 1631-1641
        • Singhal AB
        • Biller J
        • Elkind MS
        • et al.
        Recognition and management of stroke in young adults and adolescents.
        Neurology. 2013; 81: 1089-1097
        • Rasooli F
        • Zahraie MA
        • Bahreini M.
        Point-of-care ultrasound to complete physical exam and to reach the diagnosis in a young man with syncope.
        Ultrasound J. 2020; 12: 29
        • Odim J
        • Reehal V
        • Laks H
        • Mehta U
        • Fishbein MC.
        Surgical pathology of cardiac tumors. Two decades at an urban institution.
        Cardiovasc Pathol. 2003; 12: 267-270
        • Tazelaar HD.
        Pathology of surgically excised primary cardiac tumors.
        Mayo Clin Proc. 1992; 67: 957-965
        • Pinede L.
        Clinical presentation of left atrial cardiac myxoma. A series of 112 consecutive cases.
        Medicine (Baltimore). 2001; 80: 159-172
        • Lin HJ
        • Wolf PA
        • Kelly-Hayes M
        • et al.
        Stroke severity in atrial fibrillation. The Framingham Study.
        Stroke. 1996; 27: 1760-1764
        • Smajlović D.
        Strokes in young adults: epidemiology and prevention.
        Vasc Health Risk Manag. 2015; 11: 157-164
        • Singhal AB
        • Biller J
        • Elkind MS
        • et al.
        Recognition and management of stroke in young adults and adolescents.
        Neurology. 2013; 81: 1089-1097
        • Go AS
        • Hylek EM
        • Phillips KA
        • et al.
        Prevalence of diagnosed atrial fibrillation in adults: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.
        JAMA. 2001; 285: 2370-2375
        • Centofanti P
        • Di Rosa E
        • Deorsola L
        • et al.
        Primary cardiac tumors: early and late results of surgical treatment in 91 patients.
        Ann Thorac Surg. 1999; 68: 1236-1241