Clinical introduction

A 59-year-old woman with hypertension presented with right-sided weakness and vision loss. Her vital signs were normal; cardiopulmonary exam was significant for a systolic and diastolic murmur. MRI of the brain showed multiple chronic bilateral infarctions, and Doppler ultrasound revealed acute left lower extremity deep vein thrombosis. Transthoracic echocardiography (TTE) to determine cardioembolic source of stroke was significant only for severe aortic valve regurgitation. To assess for cardiac vegetations, transoesophageal echocardiography (TEE) was performed (figure 1). Thrombophilic workup revealed positive antinuclear antibody (titre 1:640) and lupus anticoagulant; the remaining …