Multiple Brain Infarction and Hemorrhage by Nonbacterial Thrombotic Endocarditis in Occult Lung Cancer—

A fifty-four-year-old woman died from multiple brain infarction and hemor rhage in the bilateral cerebrum, cerebellum, and brainstem, with renal infarc tion. She developed hematuria and transient blindness sixteen days before admission. Low-grade fever, heart murmur, and aortic valve vegetation on ul trasonic cardiography suggested infectious endocarditis. Autopsy study re vealed occult adenocarcinoma in the lung and nonbacterial thrombotic endocarditis, but infective endocarditis was not histologically confirmed. The patient was considered to be a rare case of nonbacterial thrombotic endocarditis who developed multiple small infarctions mainly in the brainstem and cerebel lum. Nonbacterial thrombotic endocarditis seems to be still an important dis ease as the embolic source, even if cryptic, of systemic thromboembolism.