Introduction: Internal carotid artery occlusion as a result of a septic embolism is a rare, commonly fatal, complication of mitral valve infectious endocarditis. Prompt recognition of this condition by the emergency physician may improve the chance of functional neurological survival. 

Case Report: A 50-year-old male presented minimally responsive with a right gaze deviation, 

left hemiparesis, and a score of 26 on the National Institutes of Health Stroke Scale. A bedside echocardiogram showed a large mitral valve vegetation, and computed tomography angiography demonstrated an internal carotid artery occlusion. 

Conclusion: The emergency physician should consider this potentially life-threatening condition and know the fundamental management recommendations once identified.