When Stroke Speaks First: A Case Report on the Hidden Face of Streptococcus mitis Endocarditis.

Multiple cerebral infarctions and intraparenchymal hemorrhages are typical complications of infective endocarditis, which can be easily misinterpreted as an indeterminate cardiac mass through non-invasive diagnostics. We present a case of a 60-year-old man with acute dysarthria, jaw clonic movement, and gaze deviation, resulting from multiple cerebral infarctions caused by infective subacute endocarditis by Streptococcus mitis, confirmed by histopathological examination after surgical heart valve resection. By means of this case, we remind clinicians of the importance of investigating infective endocarditis in any patient with unexplained multiple ischemic strokes and an indeterminate heart tumor. Medical history taking, systematic clinical examination, and a multidisciplinary approach, including heart surgery, are essential for a good diagnosis, treatment, and prognosis.