Combined neurological and cardiac rehabilitation:a tale of cardiac tumour operation during inpatient rehabilitation care

Purpose: To encourage screening for cardiac tumours in embolic stroke and improve awareness of cardiac papillary fibroelastoma (PEFs), its treatment and prognosis. Materials and methods: We report the case of a 55 year old lady who was referred for neurological rehabilitation with a diagnosis of ischaemic stroke following right sided hemiparesis and dysarthria. Echocardiogram showed non valvular left atrial tumour. Histopathology confirmed the cardiac tumour to be a cardiac papillary fibroelastoma. Her neurological rehabilitation was recommenced afterwards along with her cardiac rehabilitation with improvement in ability to manage basic activities of daily living with adaptations. Results: Transthoracic echocardiogram revealed ejection fraction of 55% and a bright mobile echogenic structure in the left atrium. Transoesophageal echocardiogram showed possible left atrial myxoma 1.3 cm x 0.96 cm. Surgical excision showed a friable and jelly like mass containing blood deposits. Histology showed papillary fibroelastoma of the left atrium. Conclusion: Cardiac causes, including Papillary fibroelastomas should be considered whilst investigating patients for secondary causes of ischaemic strokes even when they have been transferred for their neurological rehabilitation phase of their care.