Background and Aims:
The young stroke (below the ages of 45 years) occurs in 10-15% of people.  Atrial myxomas are the commonest primary cardiac tumours found on echocardiogram, and it is found in 75/1000000 autopsy studies.  Overall prevalence of cardiac tumours is 0.02%. We highlight the importance of performing thorough cardiac review on young stroke patients as rare and treatable causes may be missed.
Methods:
A 35 year old male presented with right quadrantanopia with odd rude behaviour which was unusual for him as per partner.  The MRI showed a cardio-embolic  stroke in both hemispheres.  He had CT angiogram, 24 hour Holter monitor and echocardiogram.  He also had a normal retroviral screen, autoimmune screen and lupus anticoagulant testing.  We decided to perform a transthoracic echo (TOE) which showed a mobile echogenic mass, measuring 0.8X0.6cm, attached at level of A1/P1 mitral valve scallops. He was listed for mitral valve surgery and was anticoagulated until then.
Results:
Patient underwent surgery and the tumour was a Papillary Fibroelastoma (PFE), with an incidence of 0.0002-0.33%. They have about 5% risk of embolization.
Conclusions:
We present a classic cryptogenic case of cardio embolic stroke in a young patient. His routine tests were all negative and therefore we arranged a TOE, which showed the mitral valve tumour.  We believe that this PFE was the cause of his stroke and operated on the valve. We would like to use this case to highlight the importance of vigilance in true cryptogenic strokes in the young, and consider TOE examination early in such cases.

ESOC-2019