RESUMO
Nonbacterial thromboembolic endocarditis (NBTE), or marantic endocarditis, is a rare complication associated with advanced cancer. Enoxaparin or unfractionated heparin is considered the standard treatment for NBTE. In this case report, we describe a 59-year-old female with metastatic pancreatic cancer who presented with embolic stroke and was found to have new NBTE of the mitral valve while she was receiving the therapeutic dose of enoxaparin. Of note, her recent echocardiogram one week ago was negative for mitral valve vegetations. Our case emphasized that for patients with advanced cancer presenting with stroke, the diagnosis of NBTE should be entertained even for those on systemic anticoagulation.
RESUMO
Aortic valve calcification is common in the elderly and in patients with congenital bicuspid aortic valve but unlike calcific mitral valve disease it is not a well recognized risk factor for stroke. Although autopsy studies have revealed evidence of systemic embolism in one-third of cases with calcific aortic valves, there is conflicting data from larger clinical studies examining the association between calcific aortic valve and stroke. There are only 8 reported cases of symptomatic stroke from spontaneous cerebral thromboembolism associated with calcific aortic valve in the literature. Computerized tomography (CT) angiography and CT without contrast are modalities of choice to diagnose calcific embolism, while MRI may be useful in delineating the extent of ischemia. Ideal management strategy, the role of antiplatelet therapy, anticoagulation or recommendations for valve replacements are poorly defined. We present a focused literature review on this topic.