Multiple ischemic stroke syndrome mimicking a tick-bite encephalitis: a case report

Abstract

Background: Despite the advanced diagnostic procedures nowadays, doctors remain frequently challenged with difficulties in diagnosis establishment. Some features of the patient’s history mislead even an experienced doctor. Material and methods: case report of atypical stroke. Results: A case of a 66-year-old man admitted to the Institute of Neurology and Neurosurgery from a regional hospital with severe headache, fever 38.5 C, vertigo, paresis in the left limbs, dysarthria. The patient periodically presented blood pressure spikes and generalized shivers, which hardly responded to hypotensive and antipyretic drugs. Because of the high fever, history of tick bite 2 months before the admission, absence of pathological imaging on the CT scan on admission, the patient was primarily diagnosed with Encephalitis. Lumbar puncture, blood cultures and antibiogram were performed with no pathological findings. The MRI performed on the third day after admission showed multiple sub-acute ischemic zones. Echo-CG discovered an unclear formation in the projection of the anterior mitral valve, myxoma suspected. Patient was stabilized in Neurology Department and afterwards transferred to the Cardiology Department where he was diagnosed with infectious endocarditis. Conclusions: Concomitant ischemic strokes should induce the suspicion of the underlying cardiac organic pathology. Echocardiography shall be considered for all patients with stroke; even if other risk factors are depicted. In order to prevent future strokes it is important to take all the risk factors under control.