Disclosures: Joseph G. Dadabo, MD: Nothing to disclose

Case Description: A 56-year-old woman with prior history of pelvic chondrosarcoma presented to acute care with blurred vision and dyspnea. She was found to have a large atrial mass, patent foramen ovale (PFO), and pulmonary emboli. Initial brain imaging from admission was negative for any acute intracranial findings. She was placed on a heparin drip and later underwent median sternotomy for mass resection and PFO closure. Post-operatively she was admitted to intensive care, where she was found to have reduced movement in the left arm. Repeat brain imaging identified bilateral middle cerebral artery and right anterior cerebral artery infarctions in a pattern consistent with a cardioembolic etiology. Atrial mass histology ultimately demonstrated chondrosarcoma metastases. Her course was further complicated by cerebral edema, which responded to hypertonic saline.

Setting: Acute Inpatient Rehabilitation

Patient: A 56-year-old woman with history of pelvic chondrosarcoma.

Assessment/Results: The patient presented to acute inpatient rehabilitation with left hemiparesis, left hemineglect, and hypertonia. She had previously been functionally independent, but following hospitalization required moderate to maximum assistance for activities of self care and mobility. She was on a mechanically softened diet due to dysphagia. Over the course of acute inpatient rehabilitation, she progressed to a minimum assistance level and ultimately discharged to home with her daughters.

Discussion: The patient’s pelvic chondrosarcoma had been diagnosed 14 years earlier and treated with resection and subsequent radiation. Common sites of metastasis from primary chondrosarcomas include lung, liver, brain, and kidney. The heart is an extremely rare site for metastasis, but as demonstrated in this case, a potential source of cardioembolic stroke in those with prior history of such tumors.

Conclusion: Cardiac metastasis is a potentially catastrophic sequelae of pelvic chondrosarcoma, even in those with remote history of primary tumor.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/an-atypical-cause-of-cardioembolic-stroke-in-a-patient-with-pelvic-chondrosarcoma-a-case-report/