A Palpable Source of Stroke

A 68-year-old patient was admitted with right-sided hemiplegia and dysarthria of sudden onset. His medical history included bipolar disorder, past alcohol and cigarette abuse, and untreated arterial hypertension. Clinical examination revealed a pulsatile mass in the upper epigastric region and diastasis recti, which were congenital, according to the patient. The cardiac rhythm was atrial fibrillation. Chest radiography showed rightward deviation of the heart (Figure 1A). Thoracoabdominal computed tomography disclosed protrusion of the left ventricular apex into the epigastric region, containing a round hypodense mass suggestive of a thrombus (Figure 1B). Cerebral computed tomography showed an occlusive thrombus of the proximal left middle cerebral artery without any early sign of brain ischemia (Figure 2A).Figure 1. A , Chest x-ray showing rightward deviation of the heart. B , Thoracoabdominal computed tomography, sagittal reconstruction, showing protrusion of the left ventricular apex of the heart into the epigastric region (arrow).Figure 2. A , Cerebral computed tomographic arteriography, coronal reconstruction, …