Cerebral Embolism: A Challenging Complication In Libman-Sacks Endocarditis

Libman-Sacks endocarditis is an uncommon disorder that can be a risk factor for neurocognitive dysfunction, and brain lesions, either separately or in a combination. We report 57-year-old woman from Colombia who presented with a history of dyspnea, associated with general malaise and arthralgia of small joints. On examination, she had signs of chronic arthropathy and purpuric plantar lesions. Her cardiac exam revealed a pan-systolic murmur of mitral regurgitation, harsh, grade 5/6, best heard at the apex, and a diastolic murmur in the aortic focus. Her echocardiography revealed severe mitral regurgitation and moderate aortic regurgitation with nodular thickening of both valves, consistent with a diagnosis of LSE. Blood cultures and serologic tests were negative. After starting anticoagulant treatment, the patient suffered a stroke, and it was finally decided that she would undergo surgery. She suffered a second stroke with status epilepticus in the immediate postoperative period. She eventually recovered without serious neurological sequelae.