Diagnostic Challenges in Identifying Atrial Myxoma as a Cause of Transient Ischemic Attacks: A Case Report

Abstract

Abstract Background A 67-year-old woman presented to hospital on multiple occasions with transient neurological symptoms over a period of 20 months. Initial diagnostics, including computed tomography (CT), carotid Dopplers, and electrocardiogram, were unremarkable. Magnetic resonance imaging (MRI) was arranged following the third neurological event which revealed multi-territory acute ischemic events, suggestive of a cardioembolic source. Transoesophageal echocardiography identified a large mobile atrial myxoma, histologically confirmed. Atrial myxoma, though rare, is an important cause of thromboembolic stroke, underscoring the need for comprehensive cardiac evaluation in cerebrovascular incidents. Methods The patient's case was reviewed, focusing on initial presentations, diagnostic workup, and subsequent management. Initial presentations included transient visual disturbances and transient leg weakness. Routine tests were conducted, including CT brain, carotid Dopplers, and blood tests. MRI and transoesophageal echocardiography were performed which ultimately identified the underlying cause of the patient’s neurological events. Results Initial evaluations (CT, carotid Dopplers) were normal. An MRI performed 20 months after her initial presentation revealed small acute infarcts in the right cerebellar hemisphere and left superior parietal lobe. Transoesophageal echocardiography subsequently detected a large atrial myxoma. The patient's transient symptoms and negative initial workup delayed the diagnosis, highlighting the necessity of including cardiac imaging early in the stroke workup, especially in cases of suspected cardioembolic events. Conclusion This case illustrates the critical role of thorough cardiac evaluation, including echocardiography, in diagnosing the cause of transient ischemic attacks (TIA) and strokes. The patient’s initial negative findings delayed the identification of a cardioembolic source, emphasizing the importance of comprehensive diagnostic protocols for suspected cerebrovascular events. Urgent surgical resection is essential for atrial myxoma to prevent recurrent embolic events. This report highlights the diagnostic and management challenges of cardiac myxomas, advocating for a more rigorous approach to stroke evaluation and timely intervention.