Cerebral Septic Embolism From Infective Endocarditis: Microbiological Confirmation From Mechanical Thrombectomy...

Neurological complications occurring in patients with infective endocarditis (IE) are a major determinant of morbidity and mortality. Among these, ischemic stroke secondary to septic embolism is the most common and often results from embolization of friable vegetations into the cerebral circulation. Such events typically occur early in the disease course, frequently within the first two weeks of antimicrobial therapy. The embolic material not only causes vascular occlusion but may also introduce infection into cerebral tissue, increasing the risk of secondary abscess formation, meningitis, and mycotic aneurysms. Management of acute large-vessel occlusion (LVO) stroke in IE poses unique challenges; standard intravenous thrombolysis carries a heightened risk of intracranial hemorrhage, while endovascular therapy must account for friable clot morphology and possible vessel fragility from infection-related vasculitis. The following case demonstrates the diagnosis and successful mechanical thrombectomy of an LVO in a postpartum woman with IE, with microbiological confirmation of Enterococcus faecalis directly from the retrieved thrombus, which was initially isolated from blood culture. E. faecalis is common in the genitourinary flora. This case highlights the importance of early diagnosis, vigilant monitoring for embolic events, and timely surgical intervention in infective endocarditis.