Cardioembolic Stroke from an Atrial Myxoma in a Pediatric Patient: A Case Report and Review of the Literature

Abstract

Cardioembolic stroke is an uncommon phenomenon in pediatric patients. Although the heart is the usual source of the condition, cardiac myxomas are still considered to be a rare cause in children. The case is presented of a 13-year-old, right-handed Saudi boy who showed right-sided weakness for 30 h prior to hospital admission that involved the face, arm, and leg, with slurred speech. The patient had been discharged previously from a local hospital, without active management. An examination showed decreased strength on the right side, with hyperreflexia and an up-going plantar response. The work-up included magnetic resonance imaging, which demonstrated multiple bilateral acute infarcts involving mainly the left cerebellum and a small focus in the right cerebellum. Transthoracic echocardiography demonstrated a left atrial mass measuring 1.9 cm × 2.4 cm, attached to the septum. The mass was resected after anticoagulation, and histopathology confirmed a benign myxoma. This case of cardioembolic stroke was the first to be identified in a pediatric patient in Saudi Arabia, and may easily have been missed. Brain imaging and echocardiography should be performed as soon as possible in such patients in order to guide patient management.