Infective endocarditis complicated with thalamic infarction and mycotic aneurysm rupture: a case report

A 39-year-old female with mitral valve prolapse experienced left side hemisensory disturbance four months after gastric surgery. Echocardiogram disclosed vegetation on the mitral valve and blood cultures showed growth of enterococcus. With a diagnosis of thalamic infarction complicating infective endocarditis, she was hospitalized for further treatment. After four weeks of antibiotic therapy, she developed sudden headache and obtundation. Imaging studies revealed intracerebral hemorrhage (ICH), resulting from mycotic aneurysm rupture. She survived and recovered after emergency craniotomy and evacuation of the hematoma. However, the ICH recurred six weeks later and the patient died after five days in a deep coma. Patients with mitral valve prolapse are common. Those who have systolic murmur or valvular thickening and redundancy are at particular risk of infective endocarditis and should receive antibiotic prophylaxis perioperatively as recommended by the American Heart Association. Clinical manifestations of infective endocarditis and its complications, as in our patient, are often trivial. Prompt diagnosis and intervention are crucial. In view of the poor prognosis associated with ICH due to mycotic aneurysm rupture, we suggest cerebral angiography be performed in patients presenting with focal neurologic deficits or with warning headache for early detection of accessible lesions for excision.