Brainstem stroke caused by left atrial cardiac papillary fibroelastoma: an increasingly recognized rare cause of stroke

• Published in: Cardiovascular pathology 2019-05, Vol.40, p.65-67
• Main Authors: Bonavia, Luke, Jackson, Justin, Pui-Yee Law, Jennifer, Yii, Michael, Joshi, Dhaval
• Format: Article
• Language: English
• Subjects: Atrium; Cardiac papillary fibroelastoma; Embolic stroke; Older adults; Transesophageal echocardiography
• ISSN: 1054-8807; 1879-1336
• DOI: 10.1016/j.carpath.2019.01.007

Cardiac papillary fibroelastoma is a rare but increasingly recognized cause of embolic stroke that is prevalent in the older population and requires prompt surgical management. We report an unusual case of left atrial appendage cardiac fibroelastoma in a 76-year-old gentleman who presented with left internuclear ophthalmoplegia and ataxia, with corresponding diffusion-weighted imaging on magnetic resonance imaging of the brain. This case illustrates the importance of echocardiographic imaging in the workup of cardioembolic stroke in the older adult population in the acute setting. •Cardiac papillary fibroelastoma is the most common benign cardiac tumor, occurring at a mean age of 60 and possibly having acquired multifactorial etiology.•They have frond-like morphology, a collagenous core, and mucopolysaccharide surface which may be vulnerable to embolization and thromboemboli formation.•Cardiac papillary fibroelastoma should be a differential in cardioembolic stroke in the older population, and therefore, transthoracic echocardiography is important in cardioembolic stroke workup.•Cardiac papillary fibroelastoma presents with a high risk of recurrent stroke which improves with immediate resection, so prompt removal is advised.