[Broad ischemic stroke revealing infective endocarditis in a young patient: about a case].
Broad ischemic stroke is mainly due to a cardiac embolus or to an atheromatous plaque. In young subjects, one of the main causes of ischemic stroke (broad ischemic stroke in particolar) is embolic heart disease including infective endocarditis. Infective endocarditis is a contraindication against the anticoagulant therapy (which is indicated for the treatment of embolic heart disease complicated by ischemic stroke). One neurologic complications of infective endocarditis is ischemic stroke which often occurs in multiple sites. We here report the case of a 44-year old man with afebrile acute onset of severe left hemiplegia associated with a sistolic mitral murmur, who had fever in hospital on day 5 with no other obvious source of infection present. Brain CT scan showed full broad ischaemic stroke of the right middle cerebral artery territory and doppler ultrasound, performed after stroke onset, showed infective endocarditis affecting the small mitral valve. He was treated with 4 weeks of antibiotic therapy without anticoagulant therapy ; evolution was marked by the disappearance of mitral valve vegetations and by movement sequelae involving the left side of the body. In practical terms, our problem was the onset of the fever which didn't accompany or pre-exist patient's deficit, leading us to the misdiagnosis of ischemic stroke of cardioembolic origin. This case study underlines the importance of doppler ultrasound, in the diagnosis of all broad ischemic strokes, especially superficial, before starting anticoagulant therapy.
Service de Neurologie, CHUJR Befelatanana, Antananarivo.
Fanomezantsoa Noella
FN
Ravelosaona
Service de Neurologie, CHUJR Befelatanana, Antananarivo.
Julien
J
Razafimahefa
Service de Neurologie, CHUJR Befelatanana, Antananarivo.
Rahamefy Odilon
RO
Randrianasolo
Unité de Soins Intensifs en Cardiologie, CHUJR Befelatanana, Antananarivo.
Solofonirina
S
Rakotoarimanana
Service de Neurologie, CHUJR Befelatanana, Antananarivo.
Djacoba Alain
DA
Tehindrazanarivelo
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology*; D004696:Endocarditis / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D006349:Heart Valve Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000473:pathology; D012307:Risk Factors; D020521:Stroke / Q000000981:diagnostic imaging / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D018608:Ultrasonography, Doppler / Q000379:methods
D000900:Anti-Bacterial Agents
Ischemic stroke; about young; antibiotic therapy; infective endocarditis