Background: Neurological complications of infective endocarditis are common and can cause significant morbidity and mortality. A broad spectrum of neurological manifestations may be observed. This case is used to show an approach towards the management of neurological complication of bacterial endocarditis based on a review of the published work. Case Presentation: A 26-year-old male patient was admitted to our department with sudden onset of left side weakness associated with aphasia and an intense headache. Clinical assessment showed an infective endocarditis with two mobile vegetations attached to the mitral valve complicated by an intracranial mycotic aneurysm and a brain abscess. The patient was managed only with antibiotic therapy on the decision of a multidisciplinary team, with an excellent clinical outcome. Conclusions: The management of neurologic complications of infective endocarditis remains challenging given the lack of prospective, controlled studies. Therefore, the decision process requires the participating of a multidisciplinary team.