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Septic Emboli from Endocarditis — RACP Adult Medicine MCQ

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HardNeurologySeptic Emboli from EndocarditisRACP Adult Medicine

A 68-year-old man with a mechanical aortic valve presents with fever, confusion, and multiple cranial nerve palsies. CT brain shows multiple ring-enhancing lesions. Blood cultures grow Streptococcus gallolyticus. TEE confirms a large aortic valve vegetation. What is the most likely neurological complication?

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Correct answer: E — Ischaemic stroke

Multiple ring-enhancing lesions with fever and endocarditis represent septic embolic strokes (mycotic cerebral abscesses). S. gallolyticus endocarditis requires colonoscopy to exclude colorectal malignancy (strong association). The neurological presentation is embolic cerebral infarction with secondary infection. Anticoagulation decisions in PVE with cerebral emboli are complex.

Reference: ESC – 2023 – IE Guidelines; eTG Antibiotic 2025