CARDIAC PAPILLARY FIBROELASTOMA: A RARE CAUSE OF EMBOLIC STROKE

Background and aims: Cardiac primary tumours are extremely rare. The most frequently detected are myxoma and fibroelastoma. Papillary fibroelastoma (PF) is mainly found in aortic and mitral valves. It can be diagnosed based on transthoracic echocardiography, but transesophageal echocardiography increases sensitivity among smaller tumours. PF is generally detected as an incidental finding, although it can be presented as cardiac symptomatology or embolization, being the ischemic stroke the most common presentation. We describe two ischemic stroke cases due to PF. Methods: Case 1: a 38-year-old male presented an ischemic stroke in the left posterior cerebral artery territory. Transthoracic echocardiography showed a hyperechogenic mass in the mitral valve (image 1). The examination did not show other findings. Case 2: a 66-year old male suffered an ischemic stroke in the right cerebral posterior artery territory. Usual examination did not show any pathological results. Transesophageal echocardiography showed a subvalvular mitral hyperechogenic mobile mass (11x5.5 mm) (image 2). Results: Case 1: surgical intervention extracted a 12x14 mm tumour. Histopathologic examination confirmed a PF. Case 2: surgery was postponed due to CoVid-19 pandemic. Treated with DOAC until surgery was performed. No new events. Histopathology exam confirmed the diagnosis. Neither of the patients had complications during the follow-up. No medical treatment was needed for secondary prevention. Conclusion: PF should be considered among etiological diagnoses of embolic strokes, bearing in mind secondary prevention could vary, since surgery could be a reasonable option. Transesophageal echocardiography may be a suitable option when other causes are excluded. (Figure Presented).

Bilateral facial nerve palsy associated with COVID-19 and Epstein-Barr virus co-infection.

COVID-19 can occasionally be associated with cranial nerve involvement, but facial palsy, particularly if bilateral, is exceptional. We here report a patient who presented with severe bilateral facial palsy and evidence of SARS-CoV-2 infection preceded by upper respiratory symptoms. He also had serological evidence of coinfection with Epstein-Barr virus, which could have also played a role in his neurological manifestations. PCR in the cerebrospinal fluid was negative for both EBV and SARS-CoV-2, which suggests an indirect, immune-mediated mechanism rather than direct, viral-induced damage. The patient was treated with prednisone 60 mg/24h with a tapering schedule and had a favorable outcome, with an almost complete recovery in 3 weeks. SARS-CoV-2 adds to the list of infectious agents causative of bilateral facial palsy. Coinfection with SARS-CoV-2 is not rare and should be considered in the differential diagnosis.