Embolization of infective endocarditis vegetation causes intracranial hemorrhage with hemorrhagic transformation after ischemic stroke

Abstract

Background: Infective endocarditis (IE) is a rare, but potentially fatal, infectious disease. One of the common complications of IE is the embolization of endocardial vegetation with subsequent intracerebral artery obstruction that causes acute ischemic stroke. Herein, we present a case report of a patient presenting with a neurological manifestation that turned out to be a complication of IE.

Case Illustration: We present the case of a patient with a chief complaint of left- sided hemiplegia. Blood test results revealed signs of infection. Computed tomography (CT) of the head revealed extensive infarction in the right lobe and subarachnoid hemorrhage. Echocardiography revealed vegetation on the aortic valve, suggesting that IE was the source of embolization. The patient was treated with high- dose ampicillin and gentamicin, supportive stroke therapy, and physical rehabilitation.

Conclusion: IE can be considered one of the causes of acute ischemic or hemorrhagic stroke. Ruling out other common causes of stroke and noticing signs of infection and vascular phenomena helps define the diagnosis. Echocardiography helps identify valvular vegetation to support the diagnosis. Treatment consists of high-dose penicillin and supportive therapy for stroke.