Introduction Atrial myxoma is a significant cause of stroke in younger individuals. Although it is a rare condition, it accounts for up to 0.5% of all ischemic strokes due to embolization from the cardiac tumor. Despite its sporadic occurrence, delayed treatment can lead to serious systemic and cerebral embolic events.

Case Presentation We reported a case involving a 45-year-old man with underlying schizophrenia complicated with secondary parkinsonism. He presented to us with a one-day history of dizziness, gait unsteadiness, left facial asymmetry, and drooping of the left eye. Physical examination revealed left eye internuclear ophthalmoplegia and left 3rd and 7th cranial nerve palsy. Otherwise, his limb tone was normal, and muscle strength was 5/5 throughout. An urgent CT scan of the brain showed multiple old infarcts. MRI of the brain revealed multiple lesions suggestive of arterial infarcts at left paramedian midbrain, interthalamic adhesion, and bilateral thalamus lesion and an incidental finding of a cavernoma in the right cerebellum. Echocardiography demonstrated a good ejection fraction of 61% but revealed a left atrial mass measuring 7.2–9.6 cm². He was referred to the cardiothoracic team urgently and successfully underwent complete resection of the atrial myxoma within same admission. Histopathology confirmed the mass as a cardiac myxoma. Post-operatively, he was seen in the outpatient clinic and showed minimal residual neurological deficits.

Discussion Atrial myxoma is a benign tumour yet due to its unfavourable location – it is perceived as functionally malignant. They present with a wide range of symptoms, from being asymptomatic or discovered incidentally to causing severe, life-threatening conditions. Young stroke is one its neurological manifestation through cerebral embolization. Accurate and timely diagnosis is crucial to prevent complication. The embolic potential of a myxoma seems to be linked more to its mobility than its size. Surgical resection of cardiac myxomas generally has a positive outcome. The 20-year survival rate post-surgery is approximately 85%, indicating a favourable long-term prognosis for most patients. Additionally, the recurrence rate for atrial myxomas after resection is relatively low.

Conclusion Given its heterogeneity in presentation, cardiac myxomas can frequently be overlooked during initial evaluation. Therefore, it is crucial for clinicians to thoroughly investigate young strokes and consider potential cardioembolic causes. Even a simple bedside echocardiography can be effective for early detection of such tumours.