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In the current case presentation, a patient with prosthetic mechanical mitral valve developed brain hemorrhage following head trauma. Cessation of anticoagulation treatment resulted in left atrial thrombus; patient presented with recurrent emboli events to major arteries that required recurrent embolectomy. This case highlights the clinical conflict of restarting vitamin K anticoagulation following brain hemorrhage in a high risk patient and demonstrates the importance of multimodalities imaging in assessing those patients.

A Double Edged Sword - Anticoagulation Treatment in a Patient with Mechanical Prosthetic Mitral Valve Complicated by Brain Hemorrhage