Non-Bacterial Thrombotic Endocarditis as a Cause of Cryptogenic Stroke in Malignancy

Non-bacterial thrombotic endocarditis (NBTE) is characterized by the deposition of fibrin and platelet thrombi on previously undamaged heart valves in the absence of bloodstream infection. It is associated with chronic disease states and can present with systemic embolic disease. Here we report a case of NBTE presenting as recurrent strokes in a patient with bladder cancer. Importantly, transthoracic echocardiography has limitations to detecting valvular lesions in NBTE, and providers should consider obtaining transesophageal echocardiography in the setting of high clinical suspicion.