A Tale of Three Strokes: An Intervening Twist—A Case Report

A 39-year-old lady with no previous comorbid conditions was brought to the emergency department with acute middle cerebral artery stroke.Echocardiography showed irregular immobile amorphous mass in the left atrium.She was started on anticoagulants in view of cardioembolic stroke, and her condition improved.However, she presented again with third nerve palsy and subarachnoid hemorrhage 10 days later.Digital subtraction angiography revealed a mycotic aneurysm of the right internal carotid artery.Two weeks later, she suffered from another stroke, a malignant middle cerebral artery infarct for which she required decompressive craniotomy.These recurrent neurological deficits could be linked to the atrial mass, probably atrial myxoma, the most common cardiac tumor.This case highlights that in the presence of embolic phenomena, especially in young patients with neurological symptoms, prompt neuroimaging and echocardiography, even in the absence of electrocardiogram (ECG) or auscultation abnormalities, should be considered.If an atrial myxoma is diagnosed, complications such as arrhythmias, pulmonary edema, peripheral emboli, cardioembolic stroke, intracranial hemorrhage (lobar), and fusiform cerebral aneurysms should always be watched for.Early surgical resection of the cardiac myxoma is the definitive and curative treatment to prevent morbidity and even mortality.