Emergency Physician-Performed Point-of-Care Ultrasound Identified Left Atrial Myxoma in Acute Cerebellar Infarction

Abstract

Cardiac myxoma is a rare but potentially curable cause of cardioembolic stroke. Early identification of a potential cardiac embolic source may be challenging when neurological symptoms predominate during the initial emergency department evaluation. A 72-year-old woman presented to the emergency department with acute-onset dizziness and vomiting. Although her National Institutes of Health Stroke Scale score was 0, she was unable to walk independently. Electrocardiography demonstrated newly diagnosed atrial fibrillation. Because a cardioembolic mechanism was considered, the emergency physician performed bedside cardiac point-of-care ultrasound (POCUS), which revealed a highly mobile left atrial mass attached to the interatrial septum. POCUS was performed 28 min after arrival, before brain magnetic resonance imaging, which demonstrated multiple acute cerebellar infarctions without large-vessel occlusion. Intravenous alteplase was not administered despite presentation within the therapeutic time window. Anticoagulation with intravenous unfractionated heparin was initiated. Surgical resection was postponed after hemorrhagic transformation of the cerebellar infarction was detected on hospital day 14. The patient underwent complete tumor resection on hospital day 41, and histopathological examination confirmed cardiac myxoma. She was discharged on hospital day 54 with a favorable outcome. This case illustrates the potential value of emergency physician-performed cardiac POCUS for early identification of structural cardiac abnormalities during the initial evaluation of selected patients with suspected cardioembolic stroke.