Stroke due to Nonbacterial Thrombotic Endocarditis Requiring Valve Replacement

A 30-year-old woman with a history of rectal cancer resection presented with left-sided facial palsy and dysarthria.Diffusion-weighted magnetic resonance imaging (MRI) revealed multiple cerebral infarcts, including bilateral cerebral and cerebellar hemispheres (Picture 1).MRI of the trunk revealed recurrent colorectal cancer (Picture 2).Echocar-diography showed vegetation on the mitral valve with mild to moderate mitral regurgitation (MR) (Picture 3A), which was likely the cause of the stroke.Two weeks after admission, the vegetation had enlarged and progressed to severe MR (Picture 3B).Valve replacement was performed under suspicion of infective endocarditis.A pathological examina-