A 30-year-old male with history of diabetes and intravenous drug use (IVDU) presents to the emergency department (ED) for acute onset right-sided weakness. Patient presented to the nursing staff in jail complaining of severe left sided chest pain radiating to the back. Suddenly, he became diaphoretic and developed dense aphasia. Upon arrival to the ED, his temperature was 36 degrees Celsius, blood pressure was 116/41mmHG, heart rate was 86, and respiratory rate was 18. On exam, he had complete

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... ight-sided motor weakness, facial droop, and hemineglect. CT of the head and CT angiography of the chest, abdomen, and pelvis were done emergently. CT head showed an acute infarct involving right occipital and left temporal lobes. CT angiography showed no evidence of acute vascular dissection or occlusion. An immediate bedside echocardiography was done (Images) revealing a hyper-echoic structure at the level of the aortic valve.