Case ReportsCardioembolic stroke due to papillary fibroelastoma☆
Section snippets
Case report
A 72-year-old man with hypertension and diabetes had headache, left hemiparesis, and left hemineglect. Magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) with diffusion-weighted imaging revealed an acute ischemic stroke of the posterior division of the right middle cerebral artery with embolic occlusion of this vessel. An electrocardiogram showed only 1° atrioventricular block. Carotid duplex, transcranial Doppler ultrasonography, and transthoracic echocardiography (TTE)
Discussion
PFE is a rare cardiac lesion.1, 2, 3, 4, 6 Asymptomatic lesions are occasionally identified at autopsy, cardiac surgery, echocardiography, or cardiac catheterization.1, 2, 3, 4, 6 However, neurologic events are a common occurrence, resulting from thromboembolic sequelae.4, 5, 7, 8 Embolic fragments may originate from the tumor itself or from surface formation of platelet and fibrin thrombi. The substantial risk of embolization requires prompt surgical intervention, because antithrombotic
Conclusions
PFE should be considered in the differential diagnosis of cerebral ischemia. TEE may be the sole diagnostic study to reveal important valvular abnormalities, such as PFE, and must be strongly considered in embolic stroke of unknown cause.
Acknowledgements
The authors thank Michael C. Fishbein, MD, for providing pathology images.
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Cited by (12)
Papillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation
2015, International Journal of Surgery Case ReportsCitation Excerpt :In this case, there was evidence of wound infection, so the clinical information was quite misleading. Although PFEs are benign, they can cause serious complications such as thromboembolism, myocardial ischemia, stroke and sudden death [4]. The systemic embolism is more frequently found in PFE of mitral [5].
What caused this transient or persisting ischemic event?
2019, Warlow’s Stroke: Practical ManagementPapillary fibroelastoma, unusual cause of stroke in a young man: A case report
2017, Journal of Cardiothoracic SurgeryPapillary fibroelastoma of the anterior leaflet of the mitral valve mimicking vegetation
2015, Journal of Surgical Case ReportsPapillary fibroelastoma mimicking vegetation of the mitral valve
2012, Journal of Cardiovascular UltrasoundPlacement of endovascular stent across the branching arteries: Long-term serial evaluation of stent-tissue responses overlying the arterial orifices in an experimental study
2012, CardioVascular and Interventional Radiology
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Supported by a National Stroke Association Research Fellowship Award (D.S.L.) and National Institutes of Health-National Institute of Neurological Disorders and Stroke Award K24 NS 02092-01 (J.L.S.).