Recurrent Embolic Strokes From Prosthetic Valve Endocarditis With Negative Initial Evaluation in a Non-Toxic-Appearing Patient: A Case Report

Infective endocarditis (IE) is a common cause of embolic strokes. Early diagnosis and treatment are essential to decrease the risk of ischemic stroke and ensure appropriate treatment, particularly given the higher risk of hemorrhagic complications. Treatment is also essential to prevent other complications such as heart failure, perivalvular abscesses, or intracranial abscesses. Transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) may not show endocardial involvement in the early stages of IE and, rarely, some patients may lack systemic signs of infection, making the early detection of IE challenging. Multifocal ischemic strokes may be the initial manifestation of IE and warrant further workup directed at IE even if initial echocardiogram findings are negative. A high index of clinical suspicion and thorough history are of utmost importance.