Cardiac myxomas are fragile endothelial tumors with a high incidence of cerebral embolism. After diagnosis they have to be excised as rapidly as possible. We report a patient with a myxoma of the left atrium who developed an intracranial hematoma. MRI showed multiple infarcts from repeated cerebral embolization and facilitated the decision for rapid surgery under severe heparinization. No increase of the hematoma size or further intracranial bleeding occurred. Bleeding into embolic infarction need not contraindicate relatively early maximal heparinization. The sensitivity of MRI for both ischemic and hemorrhagic changes may contribute to risk-benefit considerations affecting the management of such patients.