UOTW #31

The patient is an 11 year old male who was leaving soccer practice when his family witnessed him suddenly collapse.  He was then noted to have left sided hemiparesis associated with a headache and nausea/vomiting, and was airlifted to your emergency department.  Noncontrast CT of the brain was negative, but CTA revealed a complete proximal right M1 occlusion.  You perform a bedside echocardiogram:

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