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Septic Thromboemboli
Case Detail
| Anatomy: Brain-Spine |
 Joseph Junewick, MD FACR |
| Diagnostic Category: Vascular |
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| Created: over 2 years ago |
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| Updated: over 2 years ago |
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| Tags:
PEDS
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| Modality/Study Types:
US
MR
CT
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Activities:  PDF  ImageJA |
History
Previously well teenager with altered mental status.
Case Images
Diagnosis
Septic thromboemboli secondary to mitral valve disease
Clinical Notes
Gram positive cocci on blood and CSF evaluation.
Findings
CT – Large subtle area of hypodensity in the right middle cerebral artery distribution with multiple smaller focal areas of hypodensity.
MR – Diffusion imaging demonstrates innumerable small junctional hyperintensities with additional large right temporo-parietal defect. MRA shows abrupt termination of the right middle cerebral artery and smaller right-sided branches.
Echocardiogram – Frondlike vegetation arising from mitral valve.
Discussion
Acute endocarditis usually has an aggressive course and is related to virulent organisms such as Staphylococcus aureus and group B streptococcus. Local soft tissue destruction, septic emboli and secondary autoimmune dysfunction may occur. Native valve involvement may be related rheumatic disease, congenital heart disease, mitral valve prolapse, intravenous drug abuse, and previous catheterization.