A Woman with Left-Sided Weakness and Dysarthria

She had no vascular risk factors, but there was a 4-month history of weight loss, migratory polyarthralgia, and diffuse headaches. On examination, she had rightward gaze deviation, left homonymous hemianopia, left facial weakness, and decreased sensation on her left. CT angiography confirmed an occlusion of the proximal right middle and anterior cerebral arteries, prompting thrombolysis and thrombectomy. Her hospital course was complicated by an additional occlusion of the left middle cerebral artery requiring a second thrombectomy. Transthoracic echocardiography showed a large pedunculated mass attached to the left interatrial septum (Figure 1).