Ischemic Stroke as the First Manifestation of a Mitral Valve Papillary Fibroelastoma: A Case Report.

Cardiac papillary fibroelastomas are rare benign primary cardiac tumors that predominantly involve the endocardium. Despite their benign histological nature, they have a high embolic potential and may present as ischemic stroke, making their identification particularly relevant in the context of cryptogenic stroke. We report the case of a 52-year-old woman who presented to the emergency department with sudden-onset right-sided hemiplegia and dysarthria. Computed tomography angiography revealed occlusion of the M1 segment of the left middle cerebral artery, and she underwent intravenous thrombolysis followed by mechanical thrombectomy, with favorable clinical evolution. During the etiological workup, transthoracic echocardiography revealed an image suggestive of a mass on the posterior leaflet of the mitral valve, later confirmed by transesophageal echocardiography, raising suspicion of a papillary fibroelastoma. The patient subsequently underwent cardiac surgery, which confirmed the diagnosis. The aim of this report is to describe a rare case of ischemic stroke in association with a mitral valve papillary fibroelastoma and to highlight the importance of comprehensive etiological investigation in patients with presumed cryptogenic stroke.