• Akira Machida, Yasuhito Kawana, Itsuki Soejima, Takeshi Bo, and Eiichiro Amano.
• Department of Neurology, Tsuchiura Kyodo General Hospita. Electronic address: akinuro@tmd.ac.jp.
• J Stroke Cerebrovasc Dis. 2020 Dec 1; 29 (12): 105355.

AbstractA left atrial movable ball thrombus is unusual and may cause fatal systemic emboli or left ventricular inflow obstruction. Among movable ball thrombi, a spinning ball thrombus is a rare and devastating occurrence that results in cardioembolic stroke. Here, we report the case of an 88-year-old woman with a large spherical thrombus spinning in the left atrium when a catastrophic cardioembolic stroke recurred. She had a history of atrial fibrillation but was unable to continue anticoagulation therapy due to hemorrhagic complications and developed an initial cerebral embolism with a large thrombus attached to the left atrium. Twelve days after the initiation of anticoagulation therapy, an extensive cerebral embolism throughout the bilateral frontal lobe recurred with disturbance of consciousness. Transthoracic echocardiography revealed a large detached spherical thrombus spinning in the left atrium. She did not recover consciousness and was moved to another hospital for palliative care three months later. Movable type left atrial thrombi are regarded as a high risk for thromboembolic events, but those with spinning movements may have a worse prognosis.Copyright © 2020 Elsevier Inc. All rights reserved.

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