A 56-year-old man was brought to the emergency department (ED) after he was found seizing on the floor by his family. His brother described hearing a thump in his room and witnessed him having a full body clonic seizure that lasted approximately 2 min. When emergency medical service arrived, he was found on the floor with altered mental status and with signs of facial trauma. No medications were administered en route to the hospital.On arrival to the ED, he was initially confused and mumbling incoherently. He was noted to be only oriented to self, and would not reliably follow commands. Approximately 1 h after arrival, he became agitated, seemed more confused, and would not follow any commands. Initial vital signs were: blood pressure, 147/76 mmHg; pulse, 81/min; respiratory rate, 18/min; temperature, 35°C by tympanic measurement; and oxygen saturation was 100% on room air. On physical exam, his pupils were 4 mm and reactive bilaterally. Extraocular movements appeared intact by observation only and there was no nystagmus. He had a nasal deformity and laceration to the right side of his tongue. The chest exam was normal with the exception of a large median sternotomy scar. His abdomen was soft, nontender, and there were no signs of bladder distension. Bowel sounds were noted to be present. There was no evidence of bowel or bladder incontinence. The neurological exam was notable for decreased attention, inability to follow commands, inability to repeat examiner's phrases, and markedly reduced language skills. The patient had spastic muscle tone with resistance to motion both with flexion and extension of all extremities. Deep tendon reflexes were noted to be 2+ in bilateral upper extremities and 3+ in bilateral lower extremities without clonus.

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We report a case of altered mental status in a 5-year-old boy who presented to the emergency department after presumed head trauma. A computed tomography head was conducted and its findings were normal, and the boy was discharged home. He returned the next day with persistent altered mental status and was found to have an abnormal MR brain suggestive of embolic strokes. An echocardiogram revealed a large atrial mass that was later confirmed by pathology to be an atrial myxoma. This is a unique and, to our knowledge, unreported presentation of a known but rare disease process in a pediatric patient.