Ultrasound-Assisted Diagnosis of Embolic Cerebrovascular Accident From Left Atrial Myxoma in the Emergency Department

Abstract

Acute-onset, unilateral weakness is an alarming presentation due to the possibility of a cerebrovascular accident. When considering cerebrovascular accidents in patients younger than 35 years, emergency physicians should evaluate embolic sources. A 28-year-old man with no reported past medical history presented to the Emergency Department with a complaint of acute-onset left-sided hemiparesis and facial droop that started a day prior to arrival. He was stable, had unilateral weakness, hyperreflexia, and slightly slurred speech. He reported no sensory deficits. A computed tomography scan of the head demonstrated areas of ischemia. Patient demographics suggested an embolic source, so point-of-care-ultrasound (POCUS) was performed by emergency practitioners, leading to the discovery of a large, mobile, left atrial mass. After admission and confirmatory imaging, the mass was surgically removed. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: In young, otherwise healthy individuals, heart masses should be considered as a cause of unexplained stroke-like symptoms. POCUS can identify these masses and expedite care.