An unusual cause of ischemic stroke with successful thrombolysis

J Stroke Cerebrovasc Dis. 2013 Nov;22(8):e691-2. doi: 10.1016/j.jstrokecerebrovasdis.2013.07.027. Epub 2013 Sep 3.


A 63-year-old woman was admitted because of sudden ischemic hemyplegia promptly cleared up by intravenous (IV) recombinant tissue plasminogen activator. On subsequent 2-dimensional echocardiogram, we observed an extremely mobile homogeneous mass attached by a short stalk to ventricular insertion of anterolateral papillary muscle chordae tendineae. The mass was surgically removed. Gross anatomy showed a mass with a gelatinoids appearance formed on histology by a lining of hyperplastic endocardial cells covering a hypocellular stroma consistent with papillary fibroelastoma. Given the prompt clinical improvement with IV thrombolytic therapy, we postulate that cerebral artery occlusion was at least in part because of thrombotic material.

Keywords: Cardiac source of embolism; echocardiography; papillary fibroelastoma; stroke.

Publication types

  • Case Reports
  • Video-Audio Media

MeSH terms

  • Administration, Intravenous
  • Brain Ischemia / diagnosis
  • Brain Ischemia / drug therapy*
  • Brain Ischemia / etiology
  • Cardiac Surgical Procedures
  • Female
  • Fibrinolytic Agents / administration & dosage*
  • Fibroma / complications*
  • Fibroma / diagnosis
  • Fibroma / surgery
  • Heart Neoplasms / complications*
  • Heart Neoplasms / diagnosis
  • Heart Neoplasms / surgery
  • Humans
  • Middle Aged
  • Stroke / diagnosis
  • Stroke / drug therapy*
  • Stroke / etiology
  • Thrombolytic Therapy*
  • Tissue Plasminogen Activator / administration & dosage*
  • Treatment Outcome


  • Fibrinolytic Agents
  • Tissue Plasminogen Activator