# Ischemic Stroke as the Initial Presentation of Advanced Pancreatic Adenocarcinoma: A Case of Marantic Endocarditis

## TL;DR

A rare case where a stroke was the first sign of advanced pancreatic cancer, linked to a condition called marantic endocarditis.

## Contribution

Highlights NBTE as a potential initial sign of undiagnosed pancreatic adenocarcinoma.

## Key findings

- Ischemic stroke was the first symptom of advanced pancreatic cancer in this case.
- NBTE was identified as the underlying cause of multiple embolic events.
- The case emphasizes the need to consider NBTE in patients with unexplained embolic infarcts.

## Abstract

Nonbacterial thrombotic endocarditis (NBTE), formerly known as marantic endocarditis, is a rare condition characterized by sterile vegetations on cardiac valves and is often associated with hypercoagulable states such as adenocarcinoma. We describe a patient who presented with multiple embolic cerebrovascular accidents, ultimately found to be secondary to NBTE, which served as the initial manifestation of previously undiagnosed advanced pancreatic adenocarcinoma. This case underscores the importance of considering NBTE in patients with multifocal embolic infarcts, particularly when blood cultures are negative, echocardiography reveals valvular abnormalities without evidence of infection, and clinical suspicion for an underlying malignancy is present.