Ischemic stroke as the initial manifestation of left atrial myxoma: case report and literature review

Viridiana Millán-Martínez, Cardiology Department, Hospital General Dr. Dario Fernández Fierro, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
Gibran A. Ahued-Pozos, Cardiology Department, Hospital General Dr. Dario Fernández Fierro, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico

Atrial myxomas are the most common primary cardiac tumors, and neurological manifestations from systemic embolization may represent the initial presentation. Early recognition is essential, as embolic events significantly increase morbidity and may obscure the underlying cardiac etiology. We present the case of a 62-year-old woman with hypertension and type 2 diabetes presented with sudden left-sided weakness and paresthesias. Brain computed tomography (CT) demonstrated an ischemic infarct in the middle cerebral artery territory. Transthoracic and transesophageal echocardiography revealed a heterogeneous left atrial mass attached to the interatrial septum, suggestive of myxoma; cardiac CT confirmed these findings. She underwent successful surgical excision, with histopathology confirming a benign myxoma. Post-operative recovery was favorable, with stable neurological status and preserved ventricular function. In conclusion, ischemic stroke can be the first manifestation of a left atrial myxoma. Prompt diagnosis through echocardiography and cardiac imaging, followed by early surgical resection, is crucial to prevent recurrent embolization and optimize patient outcomes.

Keywords: Atrial myxoma. Ischemic stroke. Embolism. Echocardiography. Cardiac surgery.