Cardiac papillary fibroelastoma: source of cerebral embolism treated with intravenous thrombolysis

J Stroke Cerebrovasc Dis. Sep-Oct 2011;20(5):485-7. doi: 10.1016/j.jstrokecerebrovasdis.2010.02.013. Epub 2010 Aug 8.

Abstract

We present the case of a 41-year-old man with sudden development of left hemiparesis due to infarction of the right middle cerebral artery that was successfully treated with intravenous (IV) thrombolysis with alteplase. Transthoracic echocardiography showed a small mass in the left ventricle. The patient underwent surgical resection, and histological examination of the mass confirmed the diagnosis of papillary fibroelastoma. It remains to be investigated whether heart ultrasound evaluation should be performed before IV thrombolysis in selected patients with stroke, given the apparently increased risk of bleeding. However, IV thrombolysis should not be postponed due to a lengthy investigation, because of its potential for reducing morbidity in patients with stroke.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Biopsy
  • Echocardiography
  • Fibrinolytic Agents / administration & dosage*
  • Fibroma / complications*
  • Fibroma / diagnosis
  • Heart Neoplasms / complications*
  • Heart Neoplasms / diagnosis
  • Humans
  • Infusions, Intravenous
  • Intracranial Embolism / diagnosis
  • Intracranial Embolism / drug therapy*
  • Intracranial Embolism / etiology
  • Magnetic Resonance Imaging
  • Male
  • Paresis / etiology
  • Thrombolytic Therapy*
  • Time Factors
  • Tissue Plasminogen Activator / administration & dosage*
  • Treatment Outcome

Substances

  • Fibrinolytic Agents
  • Tissue Plasminogen Activator