2019 Volume 24 Issue 2 Pages 185-189
A 63‒year‒old Japanese man presented to our hospital with left homonymous hemianopia. Initial cranial magnetic resonance imaging (MRI) showed a subacute cerebral infarction in the right temporoparietal lobe. Electrocardiography revealed atrial fibrillation, but a transthoracic echocardiogram did not show any abnormalities. We diagnosed a cardioembolic stroke due to non‒valvular atrial fibrillation, and we initiated direct oral anticoagulant (DOAC) therapy. At 38 days after his first visit to our hospital, the patient experienced right motor weakness, and cranial MRI showed an acute cerebral infarction in the left frontal lobe. A transesophageal echocardiogram showed a mobile mass in the left atrium, suggesting a mobile thrombus. A transesophageal echocardiogram performed 1 month later did not reveal any reduction in the size of the mobile mass. The patient was eventually diagnosed with repeated cerebral embolisms due to a left atrial myxoma. A cardiac myxoma excision was performed, and the patient did not experience any further neurological deterioration post‒surgery. DOAC is increasingly used to prevent embolisms. In patients experiencing repeated cerebral embolisms despite DOAC treatment, drug adherence should be confirmed, and additional assessments including transesophageal echocardiography should be performed.
