Fig 5. 21-year-old female with Libman-Sacks Endocarditis complicated with acute transient ischemic attack and previous stroke.

A,B. These 2D and color-Doppler TEE views demonstrate a moderate size (area 0.85 cm²), sessile, and oval shaped Libman-Sacks vegetations (arrows) on the distal portions and atrial side of the anterior (aml) and posterior (pml) mitral leaflets (A) and moderate to severe eccentric mitral regurgitation as demonstrated by a large flow convergence zone (arrows) (B). C. Transcranial Doppler of the left middle cerebral artery demonstrates 1 of 4 microemboli (arrows). D. On MRI, cerebral infarcts (arrowheads) and multiple white matter lesions (arrows) for a lesion load of 7.05 cm³ were demonstrated. Her global neurocognitive dysfunction was graded as severe. E,F. After 3 months of warfarin, hydroxychloroquine, prednisone, and mycophenolate mofetil, repeat imaging demonstrated resolution of the anterior mitral valve vegetation and reduction in size (arrow) of the posterior mitral leaflet vegetation (E), reduction of mitral regurgitation to mild degree (F), resolution of cerebromicroembolism (G), and decrease in count and size of white matter lesions (arrows in H) to a lesion load of 4.2 cm³, and improvement in her global neurocognitive dysfunction to mild degree.