Intravenous thrombolysis and thrombectomy in young patients with ischaemic stroke

Cerebral embolism caused by a myxoma in the left atrium is a rare but usually fatal event. Atrial myxomas represent 50% of all primary cardiac tumors; 75% of them are located in the left atrium. Myxomas usually appear between the ages of 30 and 60. Pedunculated myxomas, which have an irregular morphology, are the type of myxoma most likely to cause embolism since they are mobile. Transoesophageal echocardiography is a safe, accurate, and non-invasive means of diagnosing these myxomas. Treatment with intravenous fibrinolysis or rescue mechanical thrombectomy is based on previously published cases. However, no guidelines or studies provide reliable evidence supporting use of these techniques. We present the case of a 17-year-old adolescent who was admitted to our hospital’s emergency department due to sudden loss of consciousness while he was exercising. He had no known drug allergies, history of drug use, or any other relevant medical history. The general examination showed a blood pressure of 110/60 mm Hg, 110 bpm, and no fever. Cardiac auscultation revealed a rhythmic heart sound with a systolic murmur that could be heard in all areas and radiated to both carotid arteries. In the neurological examination, the patient scored 32 on the NIHSS (2 + 2 + 2 + 2 + 2 + 3 + 3 + 4 + 3 + 4 + 0 + 2 + 0 + 2 + 1). Time from symptom onset to assessment by a neurologist was 45 minutes. The emergency department performed a complete blood count, which yielded normal results, and an ECG, which revealed sinus tachycardia at 108 bpm and no signs of acute ischemia. A simple cranial CT scan showed no anomalies (Fig. 1). A CT angiography performed before the intravenous fibrinolysis showed occlusion of the distal segment of the right internal carotid artery (ICA) and