A left atrial movable ball thrombus is unusual and may cause fatal systemic emboli or left ventricular inflow obstruction. Among movable ball thrombi, a spinning ball thrombus is a rare and devastating occurrence that results in cardioembolic stroke. Here, we report the case of an 88-year-old woman with a large spherical thrombus spinning in the left atrium when a catastrophic cardioembolic stroke recurred. She had a history of atrial fibrillation but was unable to continue anticoagulation therapy due to hemorrhagic complications and developed an initial cerebral embolism with a large thrombus attached to the left atrium. Twelve days after the initiation of anticoagulation therapy, an extensive cerebral embolism throughout the bilateral frontal lobe recurred with disturbance of consciousness. Transthoracic echocardiography revealed a large detached spherical thrombus spinning in the left atrium. She did not recover consciousness and was moved to another hospital for palliative care three months later. Movable type left atrial thrombi are regarded as a high risk for thromboembolic events, but those with spinning movements may have a worse prognosis.

左房活动球血栓异常，可能导致致命的全身性栓塞或左心室血流阻塞。在活动球血栓中，旋转球血栓是罕见的破坏性事件，可导致心脏栓塞性中风。在此，我们报道了一名88岁的女性，发生严重的心脏栓塞性中风时，左心房发生大的球形血栓旋转。她有心房颤动的病史，但由于出血并发症而无法继续抗凝治疗，并发展为最初的脑栓塞，左心房附着有大血栓。开始抗凝治疗后十二天，整个双侧额叶广泛发生脑栓塞，并伴有意识障碍。经胸超声心动图检查发现左心房有较大的分离的球形血栓旋转。她没有恢复意识，三个月后被转移到另一家医院接受姑息治疗。活动型左心房血栓被认为是发生血栓栓塞事件的高风险，但是那些旋转运动的人预后较差。