A 49-year-old woman presented with 2 weeks of cough and fevers and 1 week of right-sided weakness and difficulty speaking. Examination was notable for tachycardia, distant heart sounds, jugular venous distention, pulsus paradoxicus, and Janeway lesions. Neurologic examination revealed global aphasia, right homonymous hemianopsia, and a right hemiparesis. Laboratory examination was remarkable for a troponin level of 0.45 ng/mL (to convert to micrograms per liter, multiply by 1) and an erythrocyte sedimentation rate of 83 mm/h. Head computed tomography demonstrated an acute left middle cerebral artery territory infarction (Figure, A). Transthoracic echocardiogram showed a pericardial effusion, cardiac tamponade, and 3 large mobile echodensities in the left ventricle (Figure, B). Chest computed tomography demonstrated a large mediastinal mass encasing the great vessels and bronchi, innumerable pulmonary nodules, and a segmental pulmonary embolus.
Navi BB, Kawaguchi K, Hriljac I, Lavi E, DeAngelis LM, Jamieson DG. Multifocal Stroke From Tumor Emboli. Arch Neurol. 2009;66(9):1174–1175. doi:10.1001/archneurol.2009.172
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