Neurological focal signs as a first manifestation of cardiac myxoma.

Cerebral infarcts are the third most common cause of death in Spain and the leading cause of physical disability in adults. Twenty-five per cent of all strokes occur in people younger than 65. Cardiac tumours are a very rare disease with an incidence that ranges from 0.001% to 0.28% in post-mortem studies. Half of such tumours are of myxomatous origin. They are an infrequent cause of cerebral embolism and account for less than 1% of all strokes. Although they are rare, they must be considered in the differential diagnosis of all young patients with cerebral ischaemia. We present the case of a patient who experienced acute neurological deficit and prior episodes of transient cerebral ischaemia. Female patient aged 33 with a personal history of depressive syndrome and chronic anaemia that remained uncorrected after treatment with ionic iron. The patient came to the hospital due to a 2-hour transient episode of diplopia. She reported having had a similar episode previously. Upon arrival at the hospital, the patient presented no neurological symptoms. However, the examination revealed significant purpuric lesions on the thighs and crura, and on the distal parts of the upper limbs. During her stay in the emergency department, doctors performed laboratory tests, an ECG, and a cranial CT, none of which revealed pathological findings. Once the patient was admitted, doctors began the procedure described below for diagnosing stroke in young patients. (a) Haematological analysis, which revealed chronic anaemia disease with an increase in acute-phase reactants; immunology study (ANAs, ANCAs, anti-DNA, anticardiolipin and antiphospholipid, anti-Ro, anti-La, rheumatoid factor, and anti-ACh receptor antibodies) and hypercoagulation study (all results negative); (b) lumbar puncture showing absence of oligoclonal bands and negative Link and Tibbling index; (c) brain MRI showing old ischaemic lesions in cerebellar hemispheres; (d) vascular cerebral study by means of CT angiogram and neurosonology that revealed no significant haemodynamic disorders; (e) transthoracic echocardiogram (TTE) with a subsequent transoesophageal approach (TEE) showing a mass of 11 cm in the LA that suggested atrial myxoma