Ischemic stroke as initial manifestation of primary cardiac angiosarcoma: a case report

Emilio Cabra-Arellano, Department of Emergency, Christus Muguerza Hospital, UPAEP, Puebla, Mexico
Mallyolo E. Pelayo-Salazar, Department of Neurosurgery, Hospital Regional ISSSTE Puebla, Puebla, Mexico
Luz D. Tlahuiz-Cuautle, Family Medicine Unit No.6, Instituto Mexicano del Seguro Social (IMSS), Puebla, Mexico

Primary cardiac angiosarcoma (PCA) is an extremely rare and aggressive endothelial tumor, typically presenting in advanced stages and associated with a poor prognosis. Its manifestation as an ischemic stroke is exceptionally uncommon, with very few cases documented in the literature. We present the case of a 31-year-old male with no relevant cardiovascular history who arrived at the emergency department with sudden-onset aphasia and right-sided hemiparesis (1/5 Daniel’s score right thoracic extremity, 4/5 Daniel´s score right pelvic extremity). Brain computed tomography revealed an ischemic stroke, and transthoracic echocardiography demonstrated a left atrial mass. Surgical resection was performed, and histopathological analysis confirmed a PCA as the cardioembolic source of the ischemic stroke. Despite comprehensive multidisciplinary management, including surgery, chemotherapy, radiotherapy, and rehabilitation, the patient died due to disease progression and severe neurological sequelae. This case highlights the importance of including rare neoplastic causes in the differential diagnosis of cryptogenic ischemic stroke, particularly in young patients without conventional risk factors. It also emphasizes the need for broader diagnostic protocols and clinical guidelines that consider neurological symptoms as prognostic markers in cardiac oncology. Early identification through echocardiographic evaluation may be critical in improving outcomes.

Keywords: Angiosarcoma. Cerebrovascular event. Cardioembolism. Neurosurgery.