A Cryptogenic Stroke Associated With Infective Endocarditis and Antiphospholipid Antibody Syndrome: Case Report and Literature Review

Abstract

Introduction: Accurate definition of stroke etiology is crucial, as this will guide effective targets for treatment. Both antiphospholipid antibody syndrome (APS) and infective endocarditis (IE) can be independent risk factors for ischemic stroke in young adults. When an embolic stroke occurs with IE and APS simultaneously, the origin of the embolic source is difficult to identify.

Case report: A 19-year-old man was admitted to the hospital for the onset of stroke. A diagnosis of APS accompanied by IE was made after a series of examinations. We identified aortic valve vegetation as the embolic source. Although both APS and IE can induce valve vegetation, we considered IE to be the primary cause according to the infective clues. Despite treatment with ampicillin, the patient's fever persisted, and surgical aortic valve replacement was performed urgently. The patient recovered without recurrence of stroke during the 1-year follow-up.

Conclusion: A considerable challenge for physicians is evaluating all the signs suggestive of embolic sources in acute stroke and identifying the primary etiology when there are multiple causes. Early diagnosis and surgical intervention for bicuspid aortic valve (BAV) vegetation complicated by acute stroke may yield favorable clinical results.

Keywords: antiphospholipid antibody syndrome (APS); cryptogenic stroke; embolic; infective endocarditis; surgery.

Figure 1

No arterial occlusion, stenosis, or plaque was discovered in bilateral carotid arteries (A,B), vertebral arteries (C,D), and all the intracranial arteries (E,F). The high-resolution vessel wall magnetic resonance imaging (MRI) of the basilar artery shows no occlusion or stenosis (G).

Figure 2

Diffusion restriction of the left thalamus (A,B) and the right brain stem as demonstrated on diffusion-weighted magnetic resonance imaging consistent with acute ischemic infarction (C,D).