Multiple strokes due to atrial myxoma with a negative echocardiogram

We report a patient with three cerebrovascular events involving the posterior circulation, one of which occurred in conjunction with central retinal artery occlusion. The patient had constitutional findings but had a normal cardiac examination, negative echocardiogram, and negative blood cultures. Angiography on two separate occasions revealed left vertebral artery occlusion. Repeat echocardiography 10 months later, at the time of the third stroke, revealed a left atrial mass consistent with myxoma. In patients with repetitive unexplained embolic events in different vascular distributions and constitutional findings suggestive of atrial myxoma, repeat noninvasive studies are indicated even if the initial workup is negative.