A 58 year old male presented with a 14 day history of progressive forgetfulness and aggressiveness. He had a history of human immunodeficiency virus infection, ischemic cardiomyopathy, and a myxomatous mitral valve (status post Saint Jude's mitral valve replacement 8 years before presentation). International normalized ratio was supra-therapeatutic on admission. A non-contrast computed tomography of the brain indicated multiple infarcts with hemorrhagic conversion. The source was later found to be a rare case of Neisseria sicca endocarditis.