Research Day
PAPILLARY FIBROELASTOMA IN A PATIENT PRESENTING WITH MULTIFOCAL STROKE
Document Type
Abstract
Date
2021
Abstract
Introduction: Stroke is one of the leading causes of morbidity, mortality, and disability. There are a multitude of well-defined risk factors for cardioembolic stroke, including atrial fibrillation and rheumatic heart disease. Given the rarity of cardiac tumors, these tumors are often an overlooked source of cardioembolic stroke. As our case highlights, one such tumor, papillary fibroelastoma, can present with multifocal stroke.
Case History: A 68-year-old woman with a past medical history significant for lung cancer, hypertension, and benign paroxysmal positional vertigo presented with dizziness, ataxia, diplopia, headache, diaphoresis, and elevated troponin. After admission she was diagnosed with a multifocal stroke with magnetic resonance imaging of her head. A transesophageal echocardiogram (TEE) discovered two papillary fibroelastomas of the aortic valve. Following recovery from her stroke, the patient underwent surgical excision of the valve tumors.
Discussion: This case highlights the importance of a thorough workup for patients presenting with complex neurological symptoms, including dizziness and ataxia that in this case were signs of stroke. Although the incidence of cardiac tumors has been reported around 0.1%, the potential cardiovascular sequelae of these tumors from embolization are significant, including stroke, transient ischemic attack, myocardial infarction, and cardiac arrest. For this reason, in a patient without a clear cause of multifocal stroke, a TEE is warranted if papillary fibroelastoma is a consideration on the differential diagnosis. If detected early, surgical treatment may prevent recurrent cardioembolic strokes.