[Stroke as the dramatic presentation of infectious endocarditis: the importance of the clinical history]

The authors describe a case of infective subacute endocarditis due to Streptococcus mitis in a 72 year-old woman with systemic complaints and joint symptoms, that had started 4 months before, diagnosed as a polymyalgia rheumatica, who suddenly presented with aphasia and hemiplegia. The delay in the diagnosis might be justified by the disregard of some details in the clinical history owe to the anxious/depressive personality of the patient. The devastating evolution of this case report illustrates that in patients with an inflammatory syndrome and cardiac murmur clinicians should be highly alert for the hypothesis of an infective subacute endocarditis. Ischemic stroke is a dramatic and rare presentation form of the disease. A detailed physical examination should be the first clinical approach to a patient with the diagnostic hypothesis of polymyalgia rheumatica.