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Cerebral embolism from Libman-Sacks endocarditis

Beatriz Malvar1, Filipa Mendonça Almeida, Luisa Rebocho

  • 1Department of Nephrology, Hospital Espirito Santo Évora EPE, Évora, Portugal. beatrizmalvar@sapo.pt

BMJ Case Reports
|June 14, 2012
PubMed

Insights

Libman-Sacks endocarditis, linked to antiphospholipid syndrome, can cause strokes. Early diagnosis and valve surgery are crucial for managing this rare heart condition.

Area of Science:

  • Cardiology
  • Rheumatology
  • Neurology

Background:

  • Libman-Sacks endocarditis involves non-infectious vegetations on heart valves, often associated with autoimmune conditions like antiphospholipid syndrome.
  • Embolic stroke is a significant neurological complication of Libman-Sacks endocarditis.

Observation:

  • A middle-aged woman presented with transient ischemic attacks, visual loss, and central facial palsy.
  • Cerebral imaging identified multiple right-hemisphere ischemic lesions.
  • Transesophageal echocardiography revealed mitral valve vegetations, and antiphospholipid antibodies were detected.

Findings:

  • The patient was diagnosed with Libman-Sacks endocarditis after negative microbiological examination of valve tissue.
  • Mitral valve replacement with a mechanical prosthesis was performed due to extensive valvular damage.
  • Anticoagulation therapy was initiated.

Implications:

  • This case highlights the importance of suspecting Libman-Sacks endocarditis in patients with recurrent cerebral ischemia, regardless of age.
  • Valvular surgery is essential for preventing recurrent embolic events.
  • The association between Libman-Sacks endocarditis and antiphospholipid antibodies warrants greater clinical recognition.

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