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A symptomatic intramyocardial cyst, whilst a rare occurrence, is most effectively investigated using Magnetic Resonance Imaging. Furthermore, following diagnosis it can be effectively treated using a surgical approach.

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A transient ischaemic attack (TIA) is an episode of neurologic dysfunction caused by focal brain, spinal cord or retinal ischemia without acute infarction. Atherosclerotic arterial disease, cardiogenic embolism and small arterial disease secondary to hypertension are responsible for the great majority of TIAs.We report a 54-year-old patient with a history of right face, arm & leg paresis for a period of 3 hours with spontaneous recovery.His past medical history revealed a debilitating back pain for the past 6 months, poorly responsive to analgesics resulting in him being bed bound. During his ward stay intermittent spikes of low-grade fever was recorded.On routine post stroke/TIA work up, his 2D echocardiogram revealed a moderate pericardial effusion with early right atrial collapse. Following pericardiocentesis, a Contrast Enhanced CT chest was obtained to ascertain the cause for the effusion and revealed multiple miliary nodules throughout the lung fields.An MRI study of the brain with contrast showed multiple high signal intensity lesions bilaterally in the deep white matter compatible with miliary lesions and Spinal imaging showed active Tuberculosis spondylitis in the D11/12 region.A presumptive diagnosis of disseminated haematogenous TB (miliary TB) was made based on the aforesaid findings on imaging.This was supported by a strongly positive mantoux test. The patient was started on anti-tuberculous chemoprophylaxis to which his condition responded both clinically and radiologically.This case highlights how even a transient ischemic attack in an otherwise healthy patient can have several etiologies including TB in an endemic region.