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ARTHROGRYPOSIS
Joseph Junewick, MD FACR
over 8 years ago
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ARSt Case Repository

Septic Thromboemboli

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Vascular
Created: over 7 years ago
Updated: over 7 years ago
Tags: PEDS
Modality/Study Types: US MR CT
Activities:
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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.



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