2026 American Academy of Neurology Abstract Website

Objective:

Background:

Infective endocarditis (IE) is a rare, highly morbid disease with an incidence of 1.5–11.6 cases per 100,000 annually. A common complication is embolic events, occurring in 21–50% of cases due to embolization of cardiac vegetations. However, reports of concurrent multiple septic and sterile embolic strokes remain limited.

Design/Methods:

The chart of this case of a 64-year-old Caucasian male with a past medical history of type 2 diabetes mellitus and hypothyroidism was reviewed to collect history, diagnosis, and management plan as per institutional protocol of Tallahassee Memorial Hospital.

Results:

The patient had a history of aortic mechanical valve replacement and was maintained on warfarin. He initially presented with infective endocarditis of both the mechanical aortic and mitral native valve in the context of methicillin-susceptible Staphylococcus aureus sepsis and paroxysmal atrial flutter. He was treated with IV nafcillin and warfarin for endocarditis and A-flutter. After 3 weeks, he presented with right-sided weakness and confusion. Brain MRI revealed multifocal parenchymal hypodensities in bilateral cerebral and cerebellar hemispheres, consistent with multiple acute septic and sterile embolic strokes. After one week, the patient developed right-sided hemiparesis, left gaze deviation, and global aphasia. NIHSS score was 22. ASPECTS was 10. CTA of head and neck showed an occlusive thrombus within the left M1 MCA segment with minimal opacification of distal branches. CTP showed an extensive perfusion defect in the left MCA territory. MRI of the brain showed a malignant left MCA ischemic stroke. He underwent thrombectomy; however, his neurological status worsened, he was transitioned to hospice care.

Conclusions:

Concurrent septic and sterile cardioembolic strokes are rarely reported and carry devastating outcomes. This case is significant, as it highlights the need to raise awareness for early diagnosis, prevention and treatment. We encourage further research into correlation between these two conditions, and effect of thrombectomy on these cases.