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Surgical excision confirmed a benign cardiac myxoma with no further embolic events on follow-up. This case illustrates how neuro-embolic events can manifest as non-specific psychiatric or cognitive symptoms, and how early assumptions may delay appropriate diagnosis. Even after diagnosing a prothrombotic condition like APS, clinicians must look for structural cardiac lesions that may coexist and amplify embolic risk. Comprehensive aetiological assessment is essential in embolic stroke of undetermined source, especially in younger patients with atypical presentations.<\/jats:p>","DOI":"10.1136\/bcr-2025-269302","type":"journal-article","created":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T14:55:15Z","timestamp":1772031315000},"page":"e269302","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Delayed diagnosis of recurrent embolic strokes from cardiac myxoma coexisting with antiphospholipid syndrome presenting as progressive cognitive decline"],"prefix":"10.1136","volume":"19","author":[{"given":"Sherin Soosan","family":"George","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Benjamin","family":"Adam","sequence":"additional","affiliation":[{"name":"Laboratory Medicine, University of Alberta, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janek Manoj","family":"Senaratne","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"2026022506550831000_19.2.e269302.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1538-7836.2006.01753.x"},{"key":"2026022506550831000_19.2.e269302.2","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1002\/art.42624","article-title":"The 2023 ACR\/EULAR Antiphospholipid Syndrome Classification Criteria","volume":"75","author":"Barbhaiya","year":"2023","journal-title":"Arthritis Rheumatol"},{"key":"2026022506550831000_19.2.e269302.3","doi-asserted-by":"crossref","first-page":"3119","DOI":"10.1161\/STROKEAHA.120.029350","article-title":"Risk of Paradoxical Embolism (RoPE)-Estimated Attributable Fraction Correlates With the Benefit of Patent Foramen Ovale Closure: An Analysis of 3 Trials","volume":"51","author":"Kent","year":"2020","journal-title":"Stroke"},{"key":"2026022506550831000_19.2.e269302.4","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.123.040546"},{"key":"2026022506550831000_19.2.e269302.5","doi-asserted-by":"publisher","DOI":"10.1161\/STROKEAHA.112.665927"},{"key":"2026022506550831000_19.2.e269302.6","unstructured":"National Institute of Health and Clinical Excellence guideline NG128 . 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