An unusual cause of ischemic stroke with successful thrombolysis.

ABSTRACT

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.