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Yanagawa T, Ikeda S, Yoshitomi S, Shibata A, Ikeda T. A case of infectious intracranial aneurysm that formed and ruptured within a few days after occlusion of the proximal middle cerebral artery by infective endocarditis. Surg Neurol Int 2023; 14:193. [PMID: 37404512 PMCID: PMC10316150 DOI: 10.25259/sni_229_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Accepted: 05/19/2023] [Indexed: 07/06/2023] Open
Abstract
Background Embolic cerebral infarction and infectious intracranial aneurysms (IIAs) are well-known central nervous system complications of infective endocarditis (IE). In this report, we describe a rare case of cerebral infarction caused by the occlusion of the M2 inferior trunk due to IE, followed by the rapid formation and rupture of IIA. Case Description A 66-year-old woman was admitted to the hospital with a diagnosis of IE and embolic cerebral infarction after being brought to the emergency department with a 2-day history of fever and difficulty walking. After admission, she was immediately started on antibiotic therapy. Three days later, the patient suddenly became unconscious, and a head computed tomography (CT) scan showed massive cerebral hemorrhage and subarachnoid hemorrhage. Contrast-enhanced CT showed a 13-mm large aneurysm in the left middle cerebral artery (MCA) bifurcation. An emergency craniotomy was performed, and intraoperative findings revealed a pseudoaneurysm at the origin of the M2 superior trunk. Clipping was considered difficult, so trapping and internal decompression were performed. The patient died on the 11th day after surgery due to the worsening of her general condition. The pathology of the excised aneurysm was consistent with a pseudoaneurysm. Conclusion IE may cause occlusion of the proximal MCA and rapid formation and rupture of IIA. It should be noted that the location of IIA may be a short distance away from the occlusion site.
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Affiliation(s)
- Taro Yanagawa
- Corresponding author: Taro Yanagawa, Stroke Center, Sagamihara Kyodou Hospital, Midori-ku, Sagamihara, Japan.
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Greer DM, Aparicio HJ, Siddiqi OK, Furie KL. Cardiac Diseases. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00032-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Alegria S, Marques A, Cruz I, Broa AL, Pereira ARF, João I, Simões O, Pereira H. Neurological Complications in Patients with Infective Endocarditis: Insights from a Tertiary Centre. Arq Bras Cardiol 2021; 116:682-691. [PMID: 33886711 PMCID: PMC8121414 DOI: 10.36660/abc.20190586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 12/27/2019] [Indexed: 12/13/2022] Open
Abstract
Fundamento: Complicações neurológicas são comuns em pacientes com endocardite infecciosa (EI). Dados recentes sugerem que os eventos neurológicos são os principais determinantes do prognóstico e que a cirurgia é crítica para melhorar o resultado. Objetivo: Caracterizar pacientes com EI e complicações neurológicas e determinar preditores de embolização para o sistema nervoso central (SNC) e mortalidade. Métodos: Análise retrospectiva de pacientes internados em centro terciário com diagnóstico de EI no período de 2006 a 2016. Significância estatística foi definida por um valor de p <0,05. Resultados: Identificamos 148 episódios de EI, 20% dos quais tinham evidências de embolização do SNC. Em pacientes com embolização do SNC, 76% apresentaram acidente vascular cerebral isquêmico. Durante o seguimento, 35% foram submetidos à cirurgia e a mortalidade hospitalar e em um ano foi de 39%. Esses pacientes tiveram hospitalizações mais longas, mas não houve diferenças significativas em relação à mortalidade em pacientes com e sem embolização do SNC. Os preditores independentes de complicações neurológicas foram diabetes (p = 0,005) e ausência de febre na apresentação (p = 0,049). A cirurgia foi associada a menor mortalidade (0 vs. 58%; p = 0,003), enquanto os pacientes com choque séptico tiveram pior prognóstico (75 vs. 25%; p = 0,014). Na regressão multivariada de Cox, a infecção pelo vírus da imunodeficiência humana (HIV) foi o único preditor independente de mortalidade hospitalar e de 1 ano (p = 0,011 em ambos). Conclusões: Nessa população, a embolização para o SNC foi comum, mais frequentemente apresentada como acidente vascular cerebral isquêmico, e esteve associada a maior tempo de internação, embora sem diferenças significativas na mortalidade. Nos pacientes com embolização do SNC, os submetidos à cirurgia tiveram boa evolução clínica, enquanto os pacientes com choque séptico e infecção pelo HIV tiveram pior evolução. Esses resultados devem ser interpretados com cautela, levando em consideração que os pacientes com complicações mais graves ou mais frágeis foram provavelmente menos considerados para a cirurgia, resultando em viés de seleção.
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Affiliation(s)
- Sofia Alegria
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Ana Marques
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Inês Cruz
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Ana Luísa Broa
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | | | - Isabel João
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Otília Simões
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
| | - Hélder Pereira
- Hospital Garcia de Orta EPE - Cardiologia,1 Almada - Portugal
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Song SH, Bang JS, Han MS, Yun KW, Lee SY, Song MK, Kim GB, Bae EJ, Kim WH, Choi EH. Changes in the Etiology and Clinical Characteristics of Pediatric Infective Endocarditis in South Korea. Pediatr Infect Dis J 2021; 40:123-127. [PMID: 33021589 DOI: 10.1097/inf.0000000000002917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Changes in the epidemiology, clinical manifestations, and outcomes of infective endocarditis (IE) have been reported in recent years. This study was performed to analyze changing trends in the etiology of IE in children in South Korea. STUDY DESIGN A retrospective study of children with IE was conducted from 2 hospitals in Korea from 2004 to 2019. IE was defined according to the Modified Duke criteria. We analyzed the etiology and clinical outcome of 96 cases and compared the etiology with that during 1987-1997, as described in a previous study. RESULTS A total of 96 cases in 89 children satisfied the modified Duke criteria. The median age was 9.5 years. Preexisting structural heart diseases were identified in 81 cases (84.4%). Ten of the 15 cases with normal heart anatomy had a history of indwelling central venous catheters and underlying noncardiac conditions. Of the 72 identified organisms, common pathogens included Staphylococcus aureus, 24 (32.9%); viridans streptococci, 22 (30.2%); coagulase-negative staphylococci, 14 (19.2%); and Candida species, 7 (9.6). Sixty-three cases (66.7%) required surgical intervention, and the overall fatality rate was 7.9%. Compared with the period of 1987-1997, an increasing trend in the proportion of staphylococci as the etiology of IE in 2004-2019 was observed (26.7% vs. 51.8%, P = 0.029). In addition, S. aureus was associated with the high rate of developing complications (P < 0.05). CONCLUSION In South Korea, Gram-positive cocci represent 85% of all etiologic agents of IE in children with an increasing trend in the proportion of staphylococci.
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Affiliation(s)
- Seung Ha Song
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji Seok Bang
- Department of Pediatrics, Sejong General Hospital, Bucheon, South Korea
| | - Mi Seon Han
- Department of Pediatrics, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Ki Wook Yun
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Yun Lee
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Mi Kyoung Song
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Gi Beom Kim
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Jung Bae
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Woong Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Eun Hwa Choi
- From the Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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Taj S, Arshad MU, Khan H, Sidhu GS, Singh R. Infective Endocarditis Leading to Intracranial Abscess: A Case Report and Literature Review. Cureus 2021; 13:e12660. [PMID: 33585144 PMCID: PMC7872870 DOI: 10.7759/cureus.12660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Neurologic complications are a hallmark of infective endocarditis (IE). IE leading to intracranial abscess has an unfavorable prognosis. A 17-year-old boy with a past medical history of aortic valve replacement presented with fever and seizure. On examination, he had tachycardia, systolic murmur, slurred speech, meningeal signs, and right homonymous hemianopia. His laboratory analysis revealed an elevated erythrocyte sedimentation rate and C-reactive protein. The brain's magnetic resonance imaging revealed multiple ring-enhancing lesions in the frontal, occipital lobe, and occipitotemporal lobe, consistent with intracranial abscess. Transthoracic echocardiogram revealed a mobile mass adjacent to aortic value, consistent with possible infective vegetation. He was diagnosed with multiple cerebral septic emboli leading to intracranial abscess due to IE. Blood and cerebrospinal fluid culture revealed methicillin-sensitive Staphylococcus aureus growth. He was started on intravenous nafcillin and gentamycin. His condition improved gradually, and he became afebrile on hospital day four. On his recent follow-up, he was doing well.
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Affiliation(s)
- Shafaq Taj
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
| | - Muhammad Usman Arshad
- Department of Internal Medicine, Allama Iqbal Medical College, Jinnah Hospital Lahore, Lahore, PAK
| | - Hira Khan
- Internal Medicine, Islamic International Medical College, Rawalpindi, PAK
| | - Guneet S Sidhu
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, USA
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Cao GF, Bi Q. Pediatric Infective Endocarditis and Stroke: A 13-Year Single-Center Review. Pediatr Neurol 2019; 90:56-60. [PMID: 30420107 DOI: 10.1016/j.pediatrneurol.2018.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/04/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We explored the relationship between pediatric infective endocarditis and stroke. PATIENTS AND METHODS All children encountered with infective endocarditis from January 2002 to December 2015 were included as our sample, and their medical records were comprehensively reviewed. RESULTS Sixty children with infective endocarditis were identified, including 30 boys and 30 girls aged eight months to 18 years (mean ± SD: 10.3 ± 5.6), and om 43 (71.6%) of these individuals had congenital heart disease. Left-sided endocarditis occurred in 25 patients (41.7%), and vegetations were found in 58 individuals (96.6%). The most often encountered microorganisms were Streptococcus viridans and Staphylococcus aureus, which were identified in five and four patients, respectively. Postendocarditis stroke occurred in nine patients, including five with cerebral infarction, two with intracerebral hemorrhage, and one with subarachnoid hemorrhage. The remaining child experienced cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage simultaneously. The incidence of stroke in children with left-sided endocarditis was significantly higher than that of which in those who had right-sided endocarditis (32% versus 2.8%, P < 0.01). The most common manifestation of stroke was hemiparesis (55.5%). Two girls died of stroke, and the mortality rate in the patients who had stroke was significantly higher than that in those without stroke (22.2 % versus 3.9 %, P < 0.05). CONCLUSIONS Our data indicate that stroke is common among children with infective endocarditis, especially in those with left-sided endocarditis, and major stroke may increase their risk of death. Congenital heart disease is the main underlying disease in children with infective endocarditis in China.
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Affiliation(s)
- Gui-Fang Cao
- Department of Neurology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
| | - Qi Bi
- Department of Neurology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China
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Han SM, Sorabella RA, Vasan S, Grbic M, Lambert D, Prasad R, Wang C, Kurlansky P, Borger MA, Gordon R, George I. Influence of Staphylococcus aureus on Outcomes after Valvular Surgery for Infective Endocarditis. J Cardiothorac Surg 2017; 12:57. [PMID: 28728556 PMCID: PMC5520392 DOI: 10.1186/s13019-017-0623-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 07/13/2017] [Indexed: 11/10/2022] Open
Abstract
Background As Staphylococcus aureus (SA) remains one of the leading cause of infective endocarditis (IE), this study evaluates whether S. aureus is associated with more severe infections or worsened outcomes compared to non-S. aureus (NSA) organisms. Methods All patients undergoing valve surgery for bacterial IE between 1995 and 2013 at our institution were included in this study (n = 323). Clinical data were retrospectively collected from the chart review. Patients were stratified according to the causative organism; SA (n = 85) and NSA (n = 238). Propensity score matched pairs (n = 64) of SA versus NSA were used in the analysis. Results SA patients presented with more severe IE compared to NSA patients, with higher rates of preoperative vascular complications, preoperative septic shock, preoperative embolic events, preoperative stroke, and annular abscess. Among the matched pairs, there were no significant differences in 30-day (9.4% SA vs. 7.8% NSA, OR = 1.20, p = 0.76) or 1-year mortality (20.3% SA vs. 14.1% NSA, OR = 1.57, p = 0.35) groups, though late survival was significantly worse in SA patients. There was also no significant difference in postoperative morbidity between the two matched groups. Conclusions SA IE is associated with a more severe clinical presentation than IE caused by other organisms. Despite the clearly increased preoperative risk, valvular surgery may benefit SA IE patients by moderating the post-operative mortality and morbidity.
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Affiliation(s)
- Sang Myung Han
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, 177 Fort Washington Ave, MHB 7GN-435, New York, NY, 10032, USA
| | - Robert A Sorabella
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, 177 Fort Washington Ave, MHB 7GN-435, New York, NY, 10032, USA
| | - Sowmya Vasan
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, 177 Fort Washington Ave, MHB 7GN-435, New York, NY, 10032, USA
| | - Mark Grbic
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, 177 Fort Washington Ave, MHB 7GN-435, New York, NY, 10032, USA
| | - Daniel Lambert
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, 177 Fort Washington Ave, MHB 7GN-435, New York, NY, 10032, USA
| | - Rahul Prasad
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, 177 Fort Washington Ave, MHB 7GN-435, New York, NY, 10032, USA
| | - Catherine Wang
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, 177 Fort Washington Ave, MHB 7GN-435, New York, NY, 10032, USA
| | - Paul Kurlansky
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, 177 Fort Washington Ave, MHB 7GN-435, New York, NY, 10032, USA
| | - Michael A Borger
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, 177 Fort Washington Ave, MHB 7GN-435, New York, NY, 10032, USA
| | - Rachel Gordon
- Division of Infectious Diseases, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Isaac George
- Division of Cardiothoracic Surgery, New York Presbyterian Hospital - College of Physicians and Surgeons of Columbia University, 177 Fort Washington Ave, MHB 7GN-435, New York, NY, 10032, USA.
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Yuan SM, Wang GF. Cerebral mycotic aneurysm as a consequence of infective endocarditis: A literature review. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
Complications involving the central and peripheral nervous system are frequently encountered in critically ill patients. All components of the neuraxis can be involved including the brain, spinal cord, peripheral nerves, neuromuscular junction, and muscles. Neurologic complications adversely impact outcome and length of stay. These complications can be related to underlying critical illness, pre-existing comorbid conditions, and commonly used and life-saving procedures and medications. Familiarity with the myriad neurologic complications that occur in the intensive care unit can facilitate their timely recognition and treatment. Additionally, awareness of treatment-related neurologic complications may inform decision-making, mitigate risk, and improve outcomes.
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Affiliation(s)
- Clio Rubinos
- Department of Neurology, Loyola University Chicago-Stritch School of Medicine, Maywood, IL, 60153, USA
| | - Sean Ruland
- Department of Neurology, Loyola University Chicago-Stritch School of Medicine, Maywood, IL, 60153, USA.
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Lockrow J, Longstreth W, Davis AP. Intracranial Aneurysms From Presumed Infective Endocarditis. Neurohospitalist 2016; 6:80-6. [DOI: 10.1177/1941874415605879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Jason Lockrow
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Will Longstreth
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Arielle P. Davis
- Department of Neurology, University of Washington, Seattle, WA, USA
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Effectiveness and Safety of Transcatheter Closure of Perimembranous Ventricular Septal Defects in Adults. Am J Cardiol 2016; 117:980-7. [PMID: 26796197 DOI: 10.1016/j.amjcard.2015.12.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Revised: 12/17/2015] [Accepted: 12/17/2015] [Indexed: 11/22/2022]
Abstract
This study was designed to determine the long-term safety and efficacy of using modified double-disk occluders for perimembranous ventricular septal defect (pmVSD) closure in adults. From January 2004 to December 2014, 337 adults with pmVSDs were treated through transcatheter intervention using 2 types of double-disk occluders; 302 patients received a symmetrical concentric pmVSD occluder, and 35 patients received an asymmetrical concentric pmVSD occluder. All patients were followed up through electrocardiography and transthoracic echocardiography until June 2015. The success rate was 100% for both procedures. During the median 71-month follow-up period, no cases of infective endocarditis, cerebrovascular accidents, heart failure, or death occurred. Two major adverse events (0.6%) were recorded: complete atrioventricular block requiring surgical treatment in one patient and severe tricuspid valvular regurgitation requiring surgical repair in another patient. Cardiac conduction block was the most common minor adverse event. The mean left ventricular (LV) end-diastolic volume decreased from 96.6 ± 23.2 ml before intervention to 86.0 ± 22.0 ml (p <0.05) at the 6-month follow-up visit. Previously enlarged LV chambers decreased to normal sizes during the follow-up period. In conclusion, transcatheter closure of pmVSDs using modified double-disk occluders was both safe and effective and yielded excellent long-term results in adults. The potential benefits of this intervention included remodeling of the heart, a reduced incidence of infective endocarditis and prevention of LV volume overload.
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Adler CH, Hurtig HI, Jacobson MP, Russin VL, Brooks ML. A Woman with Lung and Brain Masses. J Neuroimaging 2016. [DOI: 10.1111/jon19922297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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13
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Greer DM, Homma S, Furie KL. Cardiac Diseases. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00032-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Morita K, Sasabuchi Y, Matsui H, Fushimi K, Yasunaga H. Outcomes after early or late timing of surgery for infective endocarditis with ischaemic stroke: a retrospective cohort study. Interact Cardiovasc Thorac Surg 2015; 21:604-609. [DOI: 10.1093/icvts/ivv235] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Abstract
In this review, cardiac arrest is discussed, with a focus on neuroprognostication and the emerging data, with regard to identifying more accurate predictors of neurologic outcomes in the era of therapeutic hypothermia. Topics discussed include recent controversies with regard to targeted temperature management in comatose survivors of cardiac arrest; neurologic complications associated with surgical disease and procedures, namely aortic dissection, infective endocarditis, left ventricular assist devices, and coronary artery bypass grafting; and the cause, pathogenesis, and management of neurogenic stunned myocardium.
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Behrouz R. Preoperative Cerebrovascular Evaluation in Patients With Infective Endocarditis. Clin Cardiol 2015; 38:439-42. [PMID: 25872491 DOI: 10.1002/clc.22400] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 02/01/2015] [Indexed: 11/11/2022] Open
Abstract
Approximately 12% to 40% of infective endocarditis patients experience cerebrovascular complications. One of the major clinical challenges in cerebrovascular medicine is management of infective endocarditis patients with cerebrovascular complications who require valve operations. Cerebrovascular specialists are often summoned to address appropriate preoperative brain imaging, timing of surgery, and estimation of the risk of perioperative cerebral embolization and hemorrhage. This article addresses these issues based on the available evidence.
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Affiliation(s)
- Réza Behrouz
- Division of Cerebrovascular Diseases, Department of Neurology, Ohio State University College of Medicine, Columbus, Ohio
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17
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Yaméogo NV, Seghda A, Kagambèga LJ, Diallo O, Millogo GRC, Toguyéni BJY, Samadoulougou AK, Niakara A, Simporé J, Zabsonré P. [Neurological complications of infective endocarditis in Burkina Faso. Clinical features, management and evolutionary profile]. Ann Cardiol Angeiol (Paris) 2015; 64:81-86. [PMID: 25702236 DOI: 10.1016/j.ancard.2015.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 01/20/2015] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Neurological complications are the most frequent extracardiac complications of infective endocarditis (IE). This study aimed to describe the epidemiological, clinical and paraclinical aspects, and outcome of neurological complications of infective endocarditis in three hospitals in the city of Ouagadougou in Burkina Faso. PATIENTS AND METHOD From 1 January 2009 to 31 December 2012, we included all patients suffering from IE and selected those in whom a neurological complication was objectified. Neurological involvement was sought on clinical examination but especially CT brain (ischemic infarcts, hemorrhages, aneurysms and abscesses). Blood cultures were systematic. Echocardiography was done for vegetations and characteristics. RESULTS Among 63 cases of IE, neurological complications were found in 14 patients (22.2%). The average age of patients with neurological complications was 37.4 ± 5.8 years. The sex ratio was 1.3 for women. Neurological damage consisted of nine cases of stroke (64.3%), three cases of hemorrhagic stroke (21.4%) and two cases of brain abscess (14.3%). Neurological complications had already occurred before hospitalization in 4 cases. Blood cultures were positive in 8 cases. Germs found were predominantly Staphylococcus aureus (5 cases) and Streptococcus a- viridans (2 cases). All cases of S. aureus were complicated by stroke. At echocardiography, vegetation was found in all cases. It was found on the mitral in 7 cases, the aorta in 3 cases, the mitral and aortic in 2 cases and the mitral and tricuspid in 2 cases also. The EI had occurred on a native valve in 11 cases, prosthesis in 4 cases (2 mitral and 2 aortic). The vegetations average diameter was 11.2 ± 2.1 mm (6.4 and 1 7.7 mm). Vegetations were mobile in 12 cases. The treatment consisted of antibiotics adapted to the antibiogram, neurological and cardiovascular monitoring. The evolution was marked by seven deaths (50%), including 5 deaths related to cerebral complication (71.4% of deaths). CONCLUSION This study shows that neurological complications during infective endocarditis are frequent, dominated by stroke with a high mortality.
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Affiliation(s)
- N V Yaméogo
- Service de cardiologie, CHU Yalgado Ouédraogo, 03 PB : 7022, Ouagadougou 03, Burkina Faso.
| | - A Seghda
- Service de cardiologie, CHU Yalgado Ouédraogo, 03 PB : 7022, Ouagadougou 03, Burkina Faso
| | - L J Kagambèga
- Service de cardiologie, CHU Yalgado Ouédraogo, 03 PB : 7022, Ouagadougou 03, Burkina Faso
| | - O Diallo
- Service de cardiologie, CHU Yalgado Ouédraogo, 03 PB : 7022, Ouagadougou 03, Burkina Faso
| | - G R C Millogo
- Service de cardiologie, CHU Yalgado Ouédraogo, 03 PB : 7022, Ouagadougou 03, Burkina Faso
| | - B J Y Toguyéni
- Service de cardiologie, CHU Yalgado Ouédraogo, 03 PB : 7022, Ouagadougou 03, Burkina Faso
| | - A K Samadoulougou
- Service de cardiologie, CHU Yalgado Ouédraogo, 03 PB : 7022, Ouagadougou 03, Burkina Faso
| | - A Niakara
- Service de cardiologie, CHU Yalgado Ouédraogo, 03 PB : 7022, Ouagadougou 03, Burkina Faso
| | - J Simporé
- Service de cardiologie, CHU Yalgado Ouédraogo, 03 PB : 7022, Ouagadougou 03, Burkina Faso
| | - P Zabsonré
- Service de cardiologie, CHU Yalgado Ouédraogo, 03 PB : 7022, Ouagadougou 03, Burkina Faso
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Morris NA, Matiello M, Lyons JL, Samuels MA. Neurologic complications in infective endocarditis: identification, management, and impact on cardiac surgery. Neurohospitalist 2014; 4:213-22. [PMID: 25360207 DOI: 10.1177/1941874414537077] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Neurologic complications of infective endocarditis (IE) are common and frequently life threatening. Neurologic events are not always obvious. The prediction and management of neurologic complications of IE are not easily approached algorithmically, and the impact they have on timing and ability to surgically repair or replace the affected valve often requires a painstaking evaluation and joint effort across multiple medical disciplines in order to achieve the best possible outcome. Although specific recommendations are always tailored to the individual patient, there are some guiding principles that can be used to help direct the decision-making process. Herein, we review the pathophysiology, epidemiology, manifestations, and diagnosis of neurological complications of IE and further consider the impact they have on clinical decision making.
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Affiliation(s)
- Nicholas A Morris
- Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Marcelo Matiello
- Department of Neurology, Brigham and Women's Hospital, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jennifer L Lyons
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Martin A Samuels
- Department of Neurology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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Abstract
Infective endocarditis is a serious disease of the endocardium of the heart and cardiac valves, caused by a variety of infectious agents, ranging from streptococci to rickettsia. The proportion of cases associated with rheumatic valvulopathy and dental surgery has decreased in recent years, while endocarditis associated with intravenous drug abuse, prosthetic valves, degenerative valve disease, implanted cardiac devices, and iatrogenic or nosocomial infections has emerged. Endocarditis causes constitutional, cardiac and multiorgan symptoms and signs. The central nervous system can be affected in the form of meningitis, cerebritis, encephalopathy, seizures, brain abscess, ischemic embolic stroke, mycotic aneurysm, and subarachnoid or intracerebral hemorrhage. Stroke in endocarditis is an ominous prognostic sign. Treatment of endocarditis includes prolonged appropriate antimicrobial therapy and in selected cases, cardiac surgery. In ischemic stroke associated with infective endocarditis there is no indication to start antithrombotic drugs. In previously anticoagulated patients with an ischemic stroke, oral anticoagulants should be replaced by unfractionated heparin, while in intracranial hemorrhage, all anticoagulation should be interrupted. The majority of unruptured mycotic aneurysms can be treated by antibiotics, but for ruptured aneurysms, endovascular or neurosurgical therapy is indicated.
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Affiliation(s)
- José M Ferro
- Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.
| | - Ana Catarina Fonseca
- Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
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Cruz-Flores S. Neurologic complications of valvular heart disease. HANDBOOK OF CLINICAL NEUROLOGY 2014; 119:61-73. [PMID: 24365289 DOI: 10.1016/b978-0-7020-4086-3.00006-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Valvular heart disease (VHD) is frequently associated with neurologic complications; cerebral embolism is the most common of these since thrombus formation results from the abnormalities in the valvular surfaces or from the anatomic and physiologic changes associated with valve dysfunction, such as atrial or ventricular enlargement, intracardiac thrombi, and cardiac dysrhythmias. Prosthetic heart valves, particularly mechanical valves, are very thrombogenic, which explains the high risk of thromboembolism and the need for anticoagulation for the prevention of embolism. Infective endocarditis is a disease process with protean manifestations that include not only cerebral embolism but also intracranial hemorrhage, mycotic aneurysms, and systemic manifestations such as fever and encephalopathy. Other neurologic complications include nonbacterial thrombotic endocarditis, a process associated with systemic diseases such as cancer and systemic lupus erythematosus. For many of these conditions, anticoagulation is the mainstay of treatment to prevent cerebral embolism, therefore it is the potential complications of anticoagulation that can explain other neurologic complications in patients with VHD. The prevention and management of these complications requires an understanding of their natural history in order to balance the risks posed by valvular disease itself against the risks and benefits associated with treatment.
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Affiliation(s)
- Salvador Cruz-Flores
- Department of Neurology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA.
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Ito H, Tanaka Y, Sase T, Uchida M, Yoshida Y, Sakakibara Y, Hashimoto T. Cerebral hyperperfusion syndrome following the excision of a mycotic aneurysm with superficial temporal artery-to-middle cerebral artery bypass: case report. Neurol Med Chir (Tokyo) 2013; 54:845-50. [PMID: 24257489 PMCID: PMC4533386 DOI: 10.2176/nmc.cr2013-0017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The authors report a rare case of cerebral hyperperfusion syndrome (HPS) following the excision of a mycotic aneurysm with superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass. A 74-year-old woman with infective endocarditis presented with progressive cerebral infarction and subarachnoid hemorrhage due to a mycotic aneurysm, which was excised with a STA-MCA bypass. Postoperatively, the patient developed HPS that was considered to be exacerbated by a previous ischemic event. Therefore, cerebral hemodynamics should be evaluated before bypass surgery to prevent subsequent hyperperfusion.
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Affiliation(s)
- Hidemichi Ito
- Department of Neurosurgery, St. Marianna University School of Medicine
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Walker KA, Sampson JB, Skalabrin EJ, Majersik JJ. Clinical characteristics and thrombolytic outcomes of infective endocarditis-associated stroke. Neurohospitalist 2013; 2:87-91. [PMID: 23983869 DOI: 10.1177/1941874412446199] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Our aim was to describe the clinical features of infective endocarditis (IE) in the acute stroke setting and outcomes following thrombolytic therapy. METHODS This is a single-center, retrospective, descriptive case series of IE-related stroke (IES). Infective endocarditis diagnosis was based on the modified Duke criteria. RESULTS From 2001 to 2007, 18 patients with acute stroke had definite or possible IE. Presenting stroke subtypes were: 11 ischemic stroke; 2 intracerebral hemorrhage; and 5 with a combination of ischemia and subarachnoid hemorrhage. On presentation, 6 had objective fever and 5 had subjective fever, 8 had heart murmur, and 3 had classic IE stigmata. The most common laboratory abnormalities were leukocytosis (n = 11) and anemia (n = 10). Sixteen patients had valvular vegetations on echocardiogram; 6 of 8 patients had vegetations visualized on transesophageal echocardiogram that were not detected by transthoracic echocardiogram. Two of the 3 patients with valve replacements had vegetations only on their native valves. Of 11 patients with pure ischemic stroke, 4 received thrombolytics and had hemorrhagic conversion. Overall mortality of IES was 56% (10 of 18). Mortality in pure ischemic IES patients was 29% (2 of 7, median National Institute of Health Stroke Scale [NIHSS] 13) in those not receiving thrombolytics and 75% (3 of 4, median NIHSS 14) in those receiving thrombolytics. CONCLUSIONS Though diagnosis of IE in the acute stroke setting is difficult, features of the history, examination, and laboratory data may raise concern for IE. In this case series, thrombolytics in patients with IE-associated stroke were associated with very poor outcomes.
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Affiliation(s)
- Kevin A Walker
- Department of Neurology, University of Utah, Salt Lake City, UT, USA
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23
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García-Cabrera E, Fernández-Hidalgo N, Almirante B, Ivanova-Georgieva R, Noureddine M, Plata A, Lomas JM, Gálvez-Acebal J, Hidalgo-Tenorio C, Ruíz-Morales J, Martínez-Marcos FJ, Reguera JM, de la Torre-Lima J, González ADA. Neurological Complications of Infective Endocarditis. Circulation 2013; 127:2272-84. [PMID: 23648777 DOI: 10.1161/circulationaha.112.000813] [Citation(s) in RCA: 322] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background—
The purpose of this study was to assess the incidence of neurological complications in patients with infective endocarditis, the risk factors for their development, their influence on the clinical outcome, and the impact of cardiac surgery.
Methods and Results—
This was a retrospective analysis of prospectively collected data on a multicenter cohort of 1345 consecutive episodes of left-sided infective endocarditis from 8 centers in Spain. Cox regression models were developed to analyze variables predictive of neurological complications and associated mortality. Three hundred forty patients (25%) experienced such complications: 192 patients (14%) had ischemic events, 86 (6%) had encephalopathy/meningitis, 60 (4%) had hemorrhages, and 2 (1%) had brain abscesses. Independent risk factors associated with all neurological complications were vegetation size ≥3 cm (hazard ratio [HR] 1.91),
Staphylococcus aureus
as a cause (HR 2.47), mitral valve involvement (HR 1.29), and anticoagulant therapy (HR 1.31). This last variable was particularly related to a greater incidence of hemorrhagic events (HR 2.71). Overall mortality was 30%, and neurological complications had a negative impact on outcome (45% of deaths versus 24% in patients without these complications;
P
<0.01), although only moderate to severe ischemic stroke (HR 1.63) and brain hemorrhage (HR 1.73) were significantly associated with a poorer prognosis. Antimicrobial treatment reduced (by 33% to 75%) the risk of neurological complications. In patients with hemorrhage, mortality was higher when surgery was performed within 4 weeks of the hemorrhagic event (75% versus 40% in later surgery).
Conclusions—
Moderate to severe ischemic stroke and brain hemorrhage were found to have a significant negative impact on the outcome of infective endocarditis. Early appropriate antimicrobial treatment is critical, and transitory discontinuation of anticoagulant therapy should be considered.
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Affiliation(s)
- Emilio García-Cabrera
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Nuria Fernández-Hidalgo
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Benito Almirante
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Radka Ivanova-Georgieva
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Mariam Noureddine
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Antonio Plata
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Jose M. Lomas
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Juan Gálvez-Acebal
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Carmen Hidalgo-Tenorio
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Josefa Ruíz-Morales
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Francisco J. Martínez-Marcos
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Jose M. Reguera
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Javier de la Torre-Lima
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
| | - Arístides de Alarcón González
- From the Spanish Network for Research in Infectious Diseases (REIPI), Seville, Spain (E.G.-C., N.F.-H., B.A., R.I.-G., M.N., A.P., J.M.L., J.G.-A., C.H.-T., J.R.-M., F.J.M.-M., J.M.R., J.d.l.T.-L., A.d.A.G.); Instituto de Biomedicina de Sevilla (IBIS) Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, Seville, Spain (E.G.-C., A.d.A.G.); Internal Medicine Unit, Hospital Universitario Virgen de la Victoria, Malaga, Spain (R.I.-G.); Diseases Department, Hospital Universitari Vall
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Current treatment of active infective endocarditis with brain complications. Gen Thorac Cardiovasc Surg 2013; 61:551-9. [PMID: 23553553 DOI: 10.1007/s11748-013-0241-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Indexed: 12/20/2022]
Abstract
We describe the optimal timing of surgery in active infective endocarditis patients with brain complications. (1) Non-hemorrhagic infarction: elective surgery has been recommended in patients with non-hemorrhagic infarction. However, the timing is changing to an earlier phase. Recent studies have shown that silent brain embolism and small-size infarction (15-20 mm) without coma can be operated safely without delay. On the other hand, in patients with large non-hemorrhagic infarction with impaired consciousness, early surgery is not recommended. (2) Non-ruptured infectious intracranial aneurysm: treatment strategies for patients with infectious aneurysms without rupture remain controversial. However, the treatments are generally as follows. If the intracranial aneurysm without rupture decreases in size by administration of effective antibiotics, neurosurgery will not be required and cardiac surgery can be prioritized without delay. When the aneurysm without rupture enlarges and changes its morphology, neurosurgery or endovascular surgery should be prioritized to prevent its rupture. (3) Hemorrhagic stroke: this type is classified into primary intra-cerebral hemorrhage due to simple necrotic arteritis, hemorrhagic transformation of ischemic infarcts, and rupture of intracranial infectious aneurysms. Among these, primary intracerebral hemorrhage is the most frequently observed. In patients with the primary intracerebral hemorrhage, surgery must be postponed for at least 4 weeks to prevent exacerbation of bleeding. In patients with ruptured infectious aneurysm, neurosurgery or endovascular surgery is performed initially and cardiac surgery should be postponed at least 2-3 weeks.
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25
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[Central nervous system embolism in the course of infective endocarditis]. Neurol Neurochir Pol 2013; 47:53-62. [PMID: 23487295 DOI: 10.5114/ninp.2013.32939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite the progress made in diagnosis and treatment of heart valve diseases, the incidence of infective endocarditis (IE) remains constant. It is still associated with high mortality and high rate of embolic complications, including most dangerous one, i.e. stroke. It has a significant impact on further treatment and qualifications for cardiac surgery. In this paper, the authors discuss the epidemiology, mechanisms of stroke and its impact on the qualifications for cardiac surgery. The authors discuss the problem of clinically silent central nervous system embolism in the course of IE and the usefulness of neuroimaging and markers of central nervous system damage in diagnosis of cerebral embolism.
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26
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Barsic B, Dickerman S, Krajinovic V, Pappas P, Altclas J, Carosi G, Casabé JH, Chu VH, Delahaye F, Edathodu J, Fortes CQ, Olaison L, Pangercic A, Patel M, Rudez I, Tamin SS, Vincelj J, Bayer AS, Wang A. Influence of the Timing of Cardiac Surgery on the Outcome of Patients With Infective Endocarditis and Stroke. Clin Infect Dis 2012; 56:209-17. [DOI: 10.1093/cid/cis878] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Bruno Barsic
- Hospital for Infectious Diseases, School of Medicine, Zagreb, Croatia
| | | | | | - Paul Pappas
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
| | - Javier Altclas
- Barcelona Centre for International Health Research, Spain
| | | | | | - Vivian H. Chu
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
| | | | | | | | - Lars Olaison
- Sahlgrenska University Hospital, Göteborg, Sweden
| | - Ana Pangercic
- University Hospital Centre Sestre Milosrdnice, Zagreb, Croatia
| | - Mukesh Patel
- University of Alabama at Birmingham, Birmingham Veterans Affairs Medical Center
| | - Igor Rudez
- Dubrava University Hospital, Zagreb, Croatia
| | | | | | - Arnold S. Bayer
- Geffen School of Medicine at the University of California, Los Angeles
| | - Andrew Wang
- Duke University Medical Center, Duke Clinical Research Institute, Durham, North Carolina
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27
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Yau JWY, Lee P, Wilson A, Jenkins AJ. Prosthetic valve endocarditis: what is the evidence for anticoagulant therapy? Intern Med J 2012; 41:795-7. [PMID: 22077945 DOI: 10.1111/j.1445-5994.2011.02580.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The use of anticoagulant therapy in prosthetic valve endocarditis is a controversial management issue. Some authorities believe that anticoagulation increases the potential risk of cerebral haemorrhage after a thromboembolism whereas others, however, affirm that cessation of anticoagulation itself increases the risk of thromboembolism and subsequent morbidity and mortality. We reviewed the association of anticoagulant therapy and cerebral complications in patients with prosthetic valve endocarditis. Our results suggest that anticoagulant therapy reduces the risk of thromboembolism and is not associated with increased risk of intracranial haemorrhage.
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Affiliation(s)
- J W Y Yau
- Department of Medicine, University of Melbourne, St Vincent's Hospital, Melbourne, Victoria, Australia.
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28
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Takagi Y, Higuchi Y, Kondo H, Akita K, Ishida M, Kaneko K, Hoshino R, Sato M, Ando M. The importance of preoperative magnetic resonance imaging in valve surgery for active infective endocarditis. Gen Thorac Cardiovasc Surg 2011; 59:467-71. [PMID: 21751105 DOI: 10.1007/s11748-011-0777-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 01/07/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE Valve surgery for active infective endocarditis (IE) can cause fatal brain hemorrhage. Our current study aimed to evaluate the incidence of septic cerebral lesions in active IE patients by performing preoperative magnetic resonance imaging (MRI) including T(2)*- weighted sequences and magnetic resonance angiography (MRA) before urgent valve surgery, and to investigate whether such preoperative evaluation affects postoperative outcomes. METHODS Eighteen patients were referred to our department for native valve IE during 2006-2010. Urgent surgery was indicated in cases of hemodynamic failure resulting from valve destruction, refractory sepsis, and mobile vegetations measuring >10 mm. For these patients, we performed preoperative MRI and MRA. RESULTS Males comprised 67% of the subjects, with average age 53 ± 15 years. No clinical evidence of acute stroke was noted. Of the 18 patients, urgent surgery was indicated in 15; of these, 10 (67%) showed a brain lesion related to IE: 6 patients had acute or subacute brain infarctions, 2 patients had brain infarction with brain abscess, and 2 patients had hemorrhagic brain infarction and so did not undergo urgent surgery. Thus, 13 patients underwent urgent valve surgery. Among the 5 patients who did not undergo urgent surgery, 4 patients later underwent valve surgery for healed IE. No hospital deaths or neurological complications occurred. CONCLUSION MRI of patients with active IE revealed a high incidence of cerebral lesions caused by IE. The use of MRI to detect septic embolism and intracerebral hemorrhage may provide important information for better surgical outcomes.
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Affiliation(s)
- Yasushi Takagi
- Department of Cardiovascular Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutukake-cho, Toyoake, Aichi 470-1192, Japan.
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29
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Abstract
Cardiac causes of ischemic stroke lead to severe neurological deficits from large intracranial artery occlusion compared to small vessel ischemic stroke. The most common cause of cardioembolic stroke is atrial fibrillation (AF), which has an increasing incidence with age. AF stroke trials demonstrate that anti-coagulation is superior to anti-platelet therapy in terms of ischemic stroke prevention. Recently, warfarin was compared with dabigatran, an oral, direct thrombin inhibitor, and was found to be at least equally effective in reducing ischemic stroke with less intracranial bleeding risk. Future research is investigating other direct thrombin inhibitors as potential alternatives to warfarin, which has a narrow therapeutic index, requires frequent blood monitoring, has multiple drug interactions, and a higher rate of intracranial bleeding. Other causes of cardioembolic stroke include myocardial infarction, left ventricular thrombus, reduced ejection fraction, valvular abnormalities, and endocarditis. Patent foramen ovale is a common finding on echocardiograms in patients with and without stroke (up to 20% of the population), and it is a controversial source of cryptogenic stroke. The best way to prevent cardioembolic stroke remains early detection and treatment of AF, and treating the underlying stroke mechanism. Cardiac magnetic resonance imaging is an emerging technology and reveals some sources of cardiac embolism missed by echocardiography, and might provide an additional diagnostic tool in investigating cardioembolic stroke.
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Font MÀ, Krupinski J, Arboix A. Antithrombotic medication for cardioembolic stroke prevention. Stroke Res Treat 2011; 2011:607852. [PMID: 21822469 PMCID: PMC3148601 DOI: 10.4061/2011/607852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 03/02/2011] [Accepted: 03/27/2011] [Indexed: 01/28/2023] Open
Abstract
Embolism of cardiac origin accounts for about 20% of ischemic strokes. Nonvalvular atrial fibrillation is the most frequent cause of cardioembolic stroke. Approximately 1% of population is affected by atrial fibrillation, and its prevalence is growing with ageing in the modern world. Strokes due to cardioembolism are in general severe and prone to early recurrence and have a higher long-term risk of recurrence and mortality. Despite its enormous preventive potential, continuous oral anticoagulation is prescribed for less than half of patients with atrial fibrillation who have risk factors for cardioembolism and no contraindications for anticoagulation. Available evidence does not support routine immediate anticoagulation of acute cardioembolic stroke. Anticoagulation therapy's associated risk of hemorrhage and monitoring requirements have encouraged the investigation of alternative therapies for individuals with atrial fibrillation. New anticoagulants being tested for prevention of stroke are low-molecular-weight heparins (LMWH), unfractionated heparin, factor Xa inhibitors, or direct thrombin inhibitors like dabigatran etexilate and rivaroxaban. The later exhibit stable pharmacokinetics obviating the need for coagulation monitoring or dose titration, and they lack clinically significant food or drug interaction. Moreover, they offer another potential that includes fixed dosing, oral administration, and rapid onset of action. There are several concerns regarding potential harm, including an increased risk for hepatotoxicity, clinically significant bleeding, and acute coronary events. Therefore, additional trials and postmarketing surveillance will be needed.
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Affiliation(s)
- M. Àngels Font
- Institut d'Investigacions Biomèdiques de Bellvitge (IDIBELL), Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Department of Neurology, Hospital Sant Joan de Déu de Manresa (Fundació Althaia), Catalonia, 08243 Manresa, Spain
| | - Jerzy Krupinski
- Department of Neurology, Cerebrovascular Diseases Unit, Hospital Universitari Mútua de Terrassa, Catalonia, 08227 Terrassa, Spain
| | - Adrià Arboix
- Cerebrovascular Division, Department of Neurology, Hospital Universitari Sagrat Cor, University of Barcelona, C/Viladomat 288, Catalonia, 08029 Barcelona, Spain
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Neurologic complications and outcomes of infective endocarditis in critically ill patients: The ENDOcardite en REAnimation prospective multicenter study*. Crit Care Med 2011; 39:1474-81. [DOI: 10.1097/ccm.0b013e3182120b41] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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32
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Purulent Meningitis as an Unusual Presentation of Staphylococcus aureus Endocarditis: A Case Report and Literature Review. Case Rep Med 2011; 2011:735265. [PMID: 21541188 PMCID: PMC3085484 DOI: 10.1155/2011/735265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Revised: 01/17/2011] [Accepted: 01/27/2011] [Indexed: 11/20/2022] Open
Abstract
On presentation of Staphylococcus aureus endocarditis, unusual manifestations may represent the main clinical features of the disease. Isolated bacterial meningitis as the first manifestation of endocarditis is considered to be an unusual neurological complication. Here, we describe a case S. aureus endocarditis presenting as isolated meningitis and mimicking meningococcal septicaemia. Because of the high mortality rate of the disease, the prompt recognition of this infectious syndrome is of crucial importance for the correct management of patients.
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Sonneville R, Mourvillier B, Bouadma L, Wolff M. Management of neurological complications of infective endocarditis in ICU patients. Ann Intensive Care 2011; 1:10. [PMID: 21906336 PMCID: PMC3224466 DOI: 10.1186/2110-5820-1-10] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Accepted: 04/20/2011] [Indexed: 12/30/2022] Open
Abstract
Patients with infective endocarditis (IE) are generally referred to the intensive care unit (ICU) for one or more organ dysfunctions caused by complications of IE. Neurologic events are frequent causes of ICU admission in patients with IE. They can arise through various mechanisms consisting of stroke or transient ischemic attack, cerebral hemorrhage, mycotic aneurysm, meningitis, cerebral abscess, or encephalopathy. Most complications occur early during the course of IE and are a hallmark of left-sided abnormalities of native or prosthetic valves. Occlusion of cerebral arteries, with stroke or transient ischemic attack, accounts for 40% to 50% of the central nervous system complications of IE. CT scan is the most easily feasible neuroimaging in critically unstable patients. However, magnetic resonance imaging is more sensitive and when performed should follow a standardized protocol. In patients with ischemic stroke who are already receiving oral anticoagulant therapy, this treatment should be replaced by unfractionated heparin for at least 2 weeks with a close monitoring of coagulation tests. Mounting evidence shows that, for both complicated left-sided native valve endocarditis and Staphylococcus aureus prosthetic valve endocarditis, valve replacement combined with medical therapy is associated with a better outcome than medical treatment alone. In a recent series, approximately 50% of patients underwent valve replacement during the acute phase of IE before completion of antibiotic treatment. After a neurological event, most patients have at least one indication for cardiac surgery. Recent data from literature suggest that after a stroke, surgery indicated for heart failure, uncontrolled infection, abscess, or persisting high emboli risk should not be delayed, provided that the patient is not comatose or has no severe deficit. Neurologic complications of IE contribute to a severe prognosis in ICU patients. However, patients with only silent or transient stroke had a better prognosis than patients with symptomatic events. In addition, more than neurologic event per se, a better predictor of mortality is neurologic dysfunction, which is associated with location and extension of brain damage. Patients with severe neurological impairment and those with brain hemorrhage have the worse outcome.
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Affiliation(s)
- Romain Sonneville
- Service de Réanimation Médicale et des Maladies Infectieuses, EA 3964, Université Paris 7-Denis Diderot, Hôpital Bichat-Claude Bernard, 46, rue Henri-Huchard, 75877 Paris Cedex 18, EA 3964, University Paris 7, France.
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Bain MD, Hussain MS, Gonugunta V, Katzan I, Gupta R. Successful Recanalization of a Septic Embolus with a Balloon Mounted Stent after Failed Mechanical Thrombectomy. J Neuroimaging 2011; 21:170-2. [DOI: 10.1111/j.1552-6569.2009.00457.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Nouyrigat V, Patteau G, Bajolle F, Anthoine-Milhommes MC, Chappuy H, Chéron G. [Neurological complications revealing infectious endocarditis: 2 case reports]. Arch Pediatr 2011; 18:401-4. [PMID: 21397467 DOI: 10.1016/j.arcped.2011.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2010] [Revised: 04/06/2010] [Accepted: 01/08/2011] [Indexed: 11/24/2022]
Abstract
Neurological signs are reported in less than 20% of infectious endocarditis (IE) cases. The most frequent complications include cerebral infarction, intracerebral hemorrhage, meningitis, and mycotic aneurysm. We describe two patients, one with congenital heart disease and the other with normal heart, who presented neurological manifestations and fever leading to an IE diagnosis. Neurological complications may be the first symptom of infectious endocarditis and are a major factor associated with increased morbidity and mortality. Early diagnosis and early treatment will minimize cardiac and neurological morbidities.
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Affiliation(s)
- V Nouyrigat
- Service des urgences pédiatriques, hôpital Necker-Enfants-Malades, AP-HP, faculté de médecine, université Paris Descartes, 149, rue de Sèvres, 75015 Paris, France.
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Yeates A, Mundy J, Griffin R, Marshall L, Wood A, Peters P, Shah P. Early and mid-term outcomes following surgical management of infective endocarditis with associated cerebral complications: a single centre experience. Heart Lung Circ 2011; 19:523-7. [PMID: 20435516 DOI: 10.1016/j.hlc.2010.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2010] [Revised: 02/20/2010] [Accepted: 03/10/2010] [Indexed: 12/27/2022]
Abstract
BACKGROUND Surgical management of patients with infective endocarditis (IE) who have suffered preoperative cerebrovascular complications remains controversial. This study evaluates the impact of timing from stroke to valvular surgery on the early and mid-term neurological sequelae, functional status and quality of life in this high-risk group of patients with IE. METHOD Data on 13/108 (12%) patients with IE who suffered cerebrovascular complications during the period 1998-2009 was prospectively collected. Mean follow-up was 37.2 months (100% complete). RESULTS Three of 13 (23%) suffered haemorrhagic stroke, 10/13 (77%) had embolic events (nine, stroke; one, TIA). The clinical diagnosis was made by a neurologist in 6/13 (46%) and confirmed in all by CT scan. Twelve of 13 had motor deficit involving MCA territory. Thirty-day mortality was 2/13 (one, cardiac; one, neurological) with no late deaths. The mean time from embolic stroke to surgery was 2.3 weeks (range 3-60 days). The reason for operating on eight patients in less than two weeks was heart failure in five, uncontrolled sepsis, AMI and TIA (one each). 2/8 (25%) suffered additional postoperative neurological events (one, brain death, one, new MCA stroke). On follow-up of the remaining eight patients with embolic events, five had improved neurology and three had stable neurology. The mean time to surgery from haemorrhagic stroke was 5.8 weeks (range 3-60 days). Deficit improved in two patients (<1 week, 1; >8 weeks, 1). On follow-up the NYHA class was I-II in 6/11 (56%). The EQ-5D questionnaire was used to assess quality of life. Mean index for the group was 0.67 using the US preference-weighted index score (SD 0.27). CONCLUSIONS Results regarding timing for haemorrhagic stroke cannot be defined from the small numbers. Timely surgical intervention (embolic greater than two weeks and preferably four weeks in absence of heart failure) is associated with acceptable neurological outcome, functional class and quality of life.
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Affiliation(s)
- Alexander Yeates
- Department of Cardiothoracic Surgery, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD 4120, Australia
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Grabowski M, Hryniewiecki T, Janas J, Stępińska J. Clinically overt and silent cerebral embolism in the course of infective endocarditis. J Neurol 2011; 258:1133-9. [DOI: 10.1007/s00415-010-5897-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 12/19/2010] [Accepted: 12/22/2010] [Indexed: 11/24/2022]
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38
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Secondary Prevention of Cardioembolic Stroke. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10059-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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39
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40
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Morofuji Y, Morikawa M, Yohei T, Kitagawa N, Hayashi K, Takeshita T, Suyama K, Nagata I. Significance of the T2*-weighted gradient echo brain imaging in patients with infective endocarditis. Clin Neurol Neurosurg 2010; 112:436-40. [PMID: 20363553 DOI: 10.1016/j.clineuro.2010.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 02/21/2010] [Accepted: 03/02/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although aneurysm formation accompanying parenchymal hemorrhage is one of devastating complications in the central nerves system (CNS), imaging studies of the brain are not routinely warranted in patients with infective endocarditis (IE). To assess the clinical importance for detecting silent lesions in the central nervous system, we investigated hypointense signal spots detected on the brain T2*-weighted MR imaging in patients with IE. METHODS AND RESULTS Eleven patients with IE were retrospectively reviewed. Seven patients (63.6%) showed hypointense signal spots on T2*-weighted MR images. The number of hypointense signal spots increased within only a few weeks in five patients. CONCLUSION The brain T2*-weighted MR imaging in patients with IE may have a potential role to detect CNS lesions with clinical significance of potentially high risk of intracranial hemorrhage. T2*-weighted hypointense signal spots may be specific to brain involvement, and be quite useful in monitoring CNS lesions associated with IE, even if they are asymptomatic.
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Affiliation(s)
- Yoichi Morofuji
- Department of Neurosurgery, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki, Japan
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41
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42
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Sila CA. Neurological complications of bacterial endocarditis. HANDBOOK OF CLINICAL NEUROLOGY 2010; 96:221-229. [PMID: 20109683 DOI: 10.1016/s0072-9752(09)96013-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Cathy A Sila
- Stroke & Cerebrovascular Center, Neurological Institute, University Hospitals, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
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43
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Impact of stroke on therapeutic decision making in infective endocarditis. J Neurol 2009; 257:315-21. [DOI: 10.1007/s00415-009-5364-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Revised: 10/09/2009] [Accepted: 10/15/2009] [Indexed: 10/20/2022]
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44
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Management of Infective Endocarditis in Outpatients: Clinical Experience with Outpatient Parenteral Antibiotic Therapy. South Med J 2009; 102:575-9. [DOI: 10.1097/smj.0b013e3181a4eef2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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45
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Freeman WD, Aguilar MI. Stroke prevention in atrial fibrillation and other major cardiac sources of embolism. Neurol Clin 2009; 26:1129-60, x-xi. [PMID: 19026905 DOI: 10.1016/j.ncl.2008.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The frequency of cardioembolic stroke is expected to rise as the general population ages. Much of the increase may be attributed to atrial fibrillation, the most common cause of cardioembolic stroke and one that plays a substantial role in aging adults. Other sources of cardioembolic stroke may include ventricular thrombus from myocardial infarction, heart failure, structural heart defects such as patent foramen ovale (PFO), atrial septal aneurysm, proximal aortic atheroma, valvular heart disease, and endocarditis. Diagnostic studies, such as neuroimaging, ECG, and echocardiography, are helpful in uncovering cardioembolic sources of stroke. Medical therapy is predicated on the underlying mechanism. For example, warfarin may be indicated in certain patients who have atrial fibrillation, atrial, or ventricular thrombi, and PFO with atrial septal aneurysm and cryptogenic stroke in select young patients to prevent stroke. Newer diagnostic technologies, including multidetector CT and cardiac MRI, may be useful to diagnose cardiac causes of stroke when transesophageal echocardiography is indeterminate or cryptogenic stroke is present.
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Affiliation(s)
- William D Freeman
- Departments of Neurology and Critical Care, Mayo Clinic, Cannaday 2 East, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
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Tsai TN, Lee JT, Hsu YD, Chang TH, Chang FY. Trigeminal neuralgia as a presentation of infective endocarditis. Int J Clin Pract 2008; 62:830-2. [PMID: 18412938 DOI: 10.1111/j.1742-1241.2006.01010.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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48
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Acute inflammatory demyelinating polyneuropathy and a unilateral babinski/plantar reflex. Anesthesiol Res Pract 2008; 2008:134958. [PMID: 20975794 PMCID: PMC2957103 DOI: 10.1155/2008/134958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2007] [Revised: 08/20/2007] [Accepted: 09/29/2007] [Indexed: 12/04/2022] Open
Abstract
Acquired acute demyelinating peripheral
polyneuropathy (AADP) is a general classification of pathologies
that could affect secondary the peripheral nervous system. They
are characterized by an autoimmune process directed towards
myelin. Clinically they are characterized by progressive weakness
and mild sensory changes. Acute inflammatory demyelinating
polyneuropathy often is referred to as Guillain-Barré syndrome
(GBS). GBS is the major cause of acute nontraumatic paralysis in
healthy people and it is caused by autoimmune response to viral
agents (influenza, coxsackie, Epstein-Barr virus, or
cytomegalovirus) or bacterial infective organisms (Campylobacter
jejuni, Mycoplasma pneumoniae). A detailed history, with symptoms
of progressive usually bilateral weakness, hyporeflexia, with a
typical demyelinating EMG pattern supports the diagnosis.
Progressive affection of respiratory muscles and autonomic
instability coupled with a protracted and unpredictable recovery
normally results in the need for ICU management. We present a case
report of a patient with a typical GBS presentation but with a
unilateral upgoing plantar reflex (Babinski sign). A unifying
diagnosis was made and based on a literature search in Pubmed
appears to be the first described case of its kind.
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Dickerman SA, Abrutyn E, Barsic B, Bouza E, Cecchi E, Moreno A, Doco-Lecompte T, Eisen DP, Fortes CQ, Fowler VG, Lerakis S, Miro JM, Pappas P, Peterson GE, Rubinstein E, Sexton DJ, Suter F, Tornos P, Verhagen DW, Cabell CH. The relationship between the initiation of antimicrobial therapy and the incidence of stroke in infective endocarditis: an analysis from the ICE Prospective Cohort Study (ICE-PCS). Am Heart J 2007; 154:1086-94. [PMID: 18035080 DOI: 10.1016/j.ahj.2007.07.023] [Citation(s) in RCA: 212] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2007] [Accepted: 07/20/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Embolic events to the central nervous system are a major cause of morbidity and mortality in patients with infective endocarditis (IE). The appropriate role of valvular surgery in reducing such embolic events is unclear. The purpose of this study was to determine the relationship between the initiation of antimicrobial therapy and the temporal incidence of stroke in patients with IE and to determine if this time course differs from that shown for embolic events in previous studies. METHODS Prospective incidence cohort study involving 61 tertiary referral centers in 28 countries. Case report forms were analyzed from 1437 consecutive patients with left-sided endocarditis admitted directly to participating centers. RESULTS The crude incidence of stroke in patients receiving appropriate antimicrobial therapy was 4.82/1000 patient days in the first week of therapy and fell to 1.71/1000 patient days in the second week. This rate continued to decline with further therapy. Stroke rates fell similarly regardless of the valve or organism involved. After 1 week of antimicrobial therapy, only 3.1% of the cohort experienced a stroke. CONCLUSIONS The risk of stroke in IE falls dramatically after the initiation of effective antimicrobial therapy. The falling risk of stroke in patients with IE as a whole precludes stroke prevention as the sole indication for valvular surgery after 1 week of therapy.
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Affiliation(s)
- Stuart A Dickerman
- Department of Medicine, New York University School of Medicine, New York, NY, USA.
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50
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Corral I, Martín-Dávila P, Fortún J, Navas E, Centella T, Moya JL, Cobo J, Quereda C, Pintado V, Moreno S. Trends in neurological complications of endocarditis. J Neurol 2007; 254:1253-9. [PMID: 17260173 DOI: 10.1007/s00415-006-0512-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Revised: 11/16/2006] [Accepted: 12/06/2006] [Indexed: 10/23/2022]
Abstract
Neurological complications (NCs) are a major cause of morbidity and mortality in patients with infectious endocarditis (IE). The frequency of these complications has been found to remain constant since the preantibiotic era despite profound epidemiological changes and therapeutic advances. We have reviewed retrospectively all the cases of IE attended at a single institution between 1985 and 2003, aiming to study the clinical characteristics of the NCs, and to analyse possible temporal trends in their frequency. Among 550 patients with IE, 71 (13%) suffered NCs. NCs presented more frequently in native (NVE) and prosthetic (PVE) valve endocarditis (17% and 20%, respectively) than in endocarditis associated with drug addiction (IDU-NVE) or pacemeker (6% and 9%, respectively). Cerebrovascular disorders were the most frequent NCs (60% of the patients had ischemic events and 21% had haemorrhages). Meningitis and cerebral abscess occurred in 16% and 3% of patients with NCs, respectively, and diffuse encephalopathy in 13%. Staphylococus aureus infection was the only factor associated with NCs, but only in NVE. During the study period there was a trend for increasing frequency of NCs in IE patients, probably associated to several factors: a decrease in IDUNVE, an increase in more aggressive nosocomial acquired NVE, and an increase in NVE caused by S. aureus. Mortality among patients with NCs (34%) was significantly higher than in IE patients without them (11%). During the study period mortality increased in patients with NVE and NCs.
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Affiliation(s)
- Iñigo Corral
- Servicio de Neurología, Hospital Ramón y Cajal, Carretera de Colmenar km 9.1, 28034 Madrid, Spain.
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