Acute ischemic stroke in a pediatric population is uncommon and has a different etiology from the adult population. We describe a case of acute ischemic stroke for which emergent, physician-sonographer–performed transthoracic echocardiography (TTE) changed his outcome.The patient in this case presented with left-sided hemiparesis,with subsequent CT Angiography (CTA) imaging and follow-on neurosurgical embolectomy for a proximal middle cerebral artery occlusion after which showed early recovery of muscular deficit. The cause ultimately was from an atrialmyxoma that was identified early by emergency physician-performed TTE and led to early resection possibly preventing recurrence of stroke.