Left Ventricular Myxoma-Caused Recurrent Stroke in a Middle-Aged Woman: A Case Report.

Introduction: Ischemic stroke primarily occurs in older adults, with thromboembolism representing the most common underlying etiology. However, rare causes such as left ventricular (LV) myxomas are frequently overlooked. Case Presentation: A 53-year-old Chinese woman presented in Emergency Room with acute right-sided hemiparesis and dysarthria. Initial evaluation suggested a cryptogenic stroke, and she underwent thrombolysis (rt-PA) with subsequent clinical improvement. However, she experienced a recurrent ischemic stroke two weeks later, prompting further investigation. Repeat imaging revealed a 20.3 × 13.4 mm pedunculated LV mass attached to the lateral wall - a finding initially missed on prior echocardiography performed by a junior echocardiographer due to suboptimal image quality conducted on an acutely ill, uncooperative patient. The mass's morphology was consistent with a myxoma and surgical excision was scheduled, however the patient suffered fatal cardiorespiratory arrest before intervention. Conclusion: LV myxoma is a rare but critical stroke etiology. Echocardiography remains pivotal in identifying cardiac masses. This case highlights the diagnostic challenges posed by LV myxomas and underscores the importance of a comprehensive evaluation by an experienced echocardiologist in embolic stroke, especially in uncooperative patient and with atypical clinical presentation.