Related Experiment Video
Updated: Mar 8, 2026
Visualization of Streptococcus pneumoniae within Cardiac Microlesions and Subsequent Cardiac Remodeling
Published on: April 7, 2015
[Broad ischemic stroke revealing infective endocarditis in a young patient: about a case]
Fanomezantsoa Noella Ravelosaona1, Julien Razafimahefa1, Rahamefy Odilon Randrianasolo1
1Service de Neurologie, CHUJR Befelatanana, Antananarivo.
Insights
Infective endocarditis can cause ischemic stroke, especially in younger individuals. Early Doppler ultrasound is crucial for diagnosing this condition and guiding treatment, avoiding anticoagulant therapy when contraindicated.
Area of Science:
- Neurology
- Cardiology
- Infectious Diseases
Background:
- Broad ischemic stroke often results from cardiac emboli or atheromatous plaques.
- Infective endocarditis is a significant cause of ischemic stroke in younger populations.
- Anticoagulant therapy is indicated for embolic heart disease but contraindicated in infective endocarditis.
Observation:
- A 44-year-old man presented with acute left hemiplegia and a systolic mitral murmur.
- Brain CT revealed a large ischemic stroke in the right middle cerebral artery territory.
- Infective endocarditis of the mitral valve was diagnosed via Doppler ultrasound post-stroke onset.
Findings:
- The patient received antibiotic therapy for 4 weeks without anticoagulation.
- Mitral valve vegetations resolved, but left-sided movement sequelae persisted.
- Delayed fever onset led to initial misdiagnosis of cardioembolic stroke.
Implications:
- This case highlights the importance of Doppler ultrasound in diagnosing broad ischemic strokes, particularly before initiating anticoagulant therapy.
- Prompt diagnosis of infective endocarditis is critical to avoid inappropriate anticoagulation.
- Early identification and management of infective endocarditis can prevent further embolic events and improve patient outcomes.
Abstract:
Broad ischemic stroke is mainly due to a cardiac embolus or to an atheromatous plaque. In young subjects, one of the main causes of ischemic stroke (broad ischemic stroke in particolar) is embolic heart disease including infective endocarditis. Infective endocarditis is a contraindication against the anticoagulant therapy (which is indicated for the treatment of embolic heart disease complicated by ischemic stroke). One neurologic complications of infective endocarditis is ischemic stroke which often occurs in multiple sites. We here report the case of a 44-year old man with afebrile acute onset of severe left hemiplegia associated with a sistolic mitral murmur, who had fever in hospital on day 5 with no other obvious source of infection present. Brain CT scan showed full broad ischaemic stroke of the right middle cerebral artery territory and doppler ultrasound, performed after stroke onset, showed infective endocarditis affecting the small mitral valve. He was treated with 4 weeks of antibiotic therapy without anticoagulant therapy ; evolution was marked by the disappearance of mitral valve vegetations and by movement sequelae involving the left side of the body. In practical terms, our problem was the onset of the fever which didn't accompany or pre-exist patient's deficit, leading us to the misdiagnosis of ischemic stroke of cardioembolic origin. This case study underlines the importance of doppler ultrasound, in the diagnosis of all broad ischemic strokes, especially superficial, before starting anticoagulant therapy.
