A 56-Year-Old Woman with Recurrent Strokes: A Clear Case with a Therapeutic Dilemma

Eric S. Miller, Haitham M. Hussein, Elie Gertner

Research output: Contribution to journalArticlepeer-review


A 56-year-old woman with a history of cerebral amyloid angiopathy (CAA) complicated by prior intracranial hemorrhage (ICH) was evaluated for an asymptomatic ischemic stroke discovered on screening brain MRI. On echocardiogram, she was found to have a mass on her mitral valve and strongly positive antiphospholipid antibodies. She was diagnosed with nonbacterial thrombotic (Libman-Sacks) endocarditis associated with the primary antiphospholipid syndrome (APS). The treatment decision was complicated by the history of CAA with ICH within the last year with very high risk for bleeding complications if on anticoagulation. A multidisciplinary decision was made to initiate a trial of warfarin for 3 months. She fared well and warfarin was continued. She has not had any further bleeding or ischemic events over the subsequent 1.5 years and remains on warfarin for her APS.

Original languageEnglish (US)
Pages (from-to)100-107
Number of pages8
JournalCase Reports in Neurology
Issue number1
StatePublished - Mar 13 2021

Bibliographical note

Publisher Copyright:
© 2021 S. Karger AG. All rights reserved.


  • Antiphospholipid syndrome
  • Cerebral amyloid angiopathy
  • Hemorrhagic stroke
  • Ischemic stroke
  • Stroke


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