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A 68-year-old man was admitted to this hospital because of a syncopal episode, followed by hemiparesis and altered mental status.
The patient was in his usual state of health until the morning of admission, when he suddenly lost consciousness and vomited while walking with a companion. He was transferred by ambulance to the emergency department of another hospital within 35 minutes after the onset of symptoms.
On arrival, he said he did not have chest pain or headache, but he was unable to provide other history. On examination, he was lethargic, with intermittent periods of unresponsiveness. The blood pressure was
Differential Diagnosis
Infectious Causes of Cardiac-Based Embolism
Thrombotic Causes of Cardiac-Based Embolism
Neoplastic Causes of Cardiac-Based Embolism
Primary Cardiac Tumors
Clinical Diagnosis
Dr. James L. Januzzi, Jr.'s Diagnosis
Pathological Discussion
Anatomical Diagnosis
Source Information
From the Coronary Care Unit (J.L.J.), Cardiology Division (J.L.J., J.M.G., T.G.N.), Vascular Medicine Section (J.M.G.), and the Departments of Medicine (J.L.J., J.M.G.), Radiology (R.G.G.), and Pathology (J.R.S.), Massachusetts General Hospital; and the Departments of Medicine (J.L.J., J.M.G., T.G.N.), Radiology (R.G.G.), and Pathology (J.R.S.), Harvard Medical School.
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