A 43-year-old woman with a history of headache and smoking.
She had had episodes of blurred vision for one year, sometimes visual loss in the right hemifield, accompanied by headaches that subsided after analgesic treatment.
Nine months ago she presented a transient left hemispheric ictal episode that disappeared after 30 minutes.
On the morning of this admission, he noticed clumsiness in his right hand, deviation of the oral commissure and difficulty in articulating the word.
For this reason she came to the emergency room and was assessed by the neurologist who observed right supranuclear facial paresis and mild dysarthria, instability of the right upper limb with clumsiness for fine movements and tactile hypoesthesia.
In the emergency room ECG, in sinus rhythm, a cranial CAT scan was performed, which initially showed no signs of infarction and Doppler of the supraaortic and transcraneal trunks that were normal.
It was decided to enter the plant, requiring laboratory tests including hypercoagulability studies, ANAS, c-ANCA, p-ANCA, native DNA and antimitochondral antibodies.
Imaging tests: brain MRI and echocardiography.
MRI showed acute ischemic infarction in the upper silvian territory of the left middle cerebral artery.
Antineutrophil antibodies, antinuclear antibodies, anticentromere and antimitochondria were negative.
Thrombophilia study detected only mild hyperphosphatemia.
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Finally, echocardiography was performed, a test that was crucial in providing the definitive diagnosis of a pedunculated mass in UA that prolapsed through the mitral valve in diastole, corresponding to a myxoma with a 26 x
She was programmed for surgery, performing previously cardiac MRI to determine more accurately the morphological characteristics of the atrial mass.
A left atriotomy was performed, removing the tumour as a whole, with a morulated appearance.
The right atrium was opened and the implantation site was resected, and the atrial septal defect closed.
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The postoperative evolution was very satisfactory, being discharged without neurological deficit.
