MULTIPLE BRAIN INFARCTION AND HEMORRHAGE BY NONBACTERIAL THROMBOTIC ENDOCARDITIS IN OCCULT LUNG-CANCER - A CASE-REPORT

A fifty-four-year-old woman died from multiple brain infarction and he morrhage in the bilateral cerebrum, cerebellum, and brainstem, with re nal infarction. She developed hematuria and transient blindness sixtee n days before admission. Low-grade fever, heart murmur, and aortic val ve vegetation on ultrasonic cardiography suggested infectious endocard itis. Autopsy study revealed occult adenocarcinoma in the lung and non bacterial 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 cerebellum. Nonbacterial throm botic endocarditis seems to be still an important disease as the embol ic source, even if cryptic, of systemic thromboembolism.