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Joseph Junewick, MD FACR
over 10 years ago
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Septic Thromboemboli

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Vascular
Created: over 11 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: US MR CT
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Previously well teenager with altered mental status.

Case Images


Septic thromboemboli secondary to mitral valve disease

Clinical Notes

Gram positive cocci on blood and CSF evaluation.


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.


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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