Four Years of Altering Neurological Symptoms: A Rare Case of a Massive Left Ventricular Thrombus in the Absence of Any Symptomatic Cardiac Disease

Cerebral Thrombemboli with left ventricular origin are occasionally seen in patients with post-infarction left ventricular aneurysm or dilatative cardiomyopathy of non-ischemic cause. Freedom of medical history of cardiac disease and corresponding symptoms may delay the proper diagnosis, particularly in patients with distinct neurological symptoms and normal findings in electrocardiogram or cerebral MRI. We report on a rare case of long standing neurological symptoms and late diagnosis of a left ventricular thrombus without clinical symptoms or medical history of cardiac disease. The patient underwent a thrombus extraction via left ventricular apical approach. He was discharged from hospital after an uneventful course in our clinic with remaining mild neurological symptoms that were partially recurrent under physiotherapy and logopedic therapy in the course of the following two years. An echocardiographical evaluation of cardiac function and exclusion of a cardiac source of emboli as a first line diagnostic tool may have led to an early diagnosis. Therefore, it should be implemented in the routine examination, independent of cardiac history or present cardiac symptoms.