Recidiverende herseninfarcten met een bijzondere en maligne oorzaak

Abstract

Nonbacterial thrombotic endocarditis: a case report A patient presented to the emergency room with a right-sided headache since the night before and gait problems. Neurological examination showed a left-sided hemianopia and a left-sided sensorimotor hemiparesis. A CT scan of the brain revealed an ischemic stroke. The patient was treated already with dabigatran and clopidogrel because of a previous ischemic stroke. Due to the presence of infarctions in the perfusion territories of both the middle and posterior cerebral artery, further investigation to look for a cardio-embolic cause was performed. The history of a bronchial adenocarcinoma and the absence of infectious symptoms raised the suspicion of nonbacterial thrombotic endocarditis. A transoesophageal echocardiography showed a hypodense structure on the mitral valve, thereby confirming this diagnosis. Despite anticoagulation with low-molecular-weight heparin, the patient died shortly afterwards as a result of a new, severe ischemic stroke.