Woman, 83 years, with hypertension and dyslipidemia, came to emergency room for sudden dysarthria and facial paralysis. Physical examination was normal, except mitral regurgitation murmur. Biological tests normal. Cerebral CT revealed lacune in left corona radiata whereas angio-CT showed only moderate atherosclerosis of the carotid arteries. Cerebral MRI (Figure 1) exposed multiple infra- and supratentorial infarcts suggesting cardioembolic strokes.
Cardiac CT (Figure 2) performed in order to analyze this valvular pseudotumor revealed a large calcified tumor, inserted to the mitral annulus evocating caseous necrosis. Transesophageal echocardiography (Figure 3) allowed high-quality images and excluded thrombi and foramen ovale. Is it a caseous necrosis presenting as a left ventricular pseudotumor and revealed by transient ischemic attack. Should surgical excision be done to prevent…