Cerebrovascular Complications in Patients with Left‐Sided Infective Endocarditis Are Common: A Prospective Study Using Magnetic Resonance Imaging and Neurochemical Brain Damage Markers

Abstract

Background. @nbsp; Cerebrovascular complications (CVCs) have remained a major therapeutic and prognostic challenge associated with infective endocarditis, and definite risk factors have not been fully elucidated. This prospective study was designed to the evaluate the total incidence of CVC associated with infective endocarditis and major risk factors. Methods. @nbsp; During 2 study periods, from June 1998 through April 2001 and from September 2002 through January 2005, patients were prospectively enrolled in the study regardless of neurological symptoms. Study patients underwent neurological examinations and magnetic resonance imaging of the brain, and cerebrospinal fluid analyses of inflammatory and neurochemical markers of brain damage (neurofilament protein and glial fibrillary acidic protein) were performed. Results. @nbsp; Sixty patients who experienced episodes of left-sided infective endocarditis were evaluated; 35% of these patients experienced a symptomatic CVC. Silent cerebral complications were detected in another 30% of the patients, and the total CVC rate was 65% (95% confidence interval, 58%-72%). Five percent of patients experienced their first neurological symptom after the initiation of antibiotic treatment without prior surgery. No new symptomatic CVCs were detected after 10 days of antibiotic treatment. No neurological deterioration was observed after surgery in patients who were established to have a symptomatic CVC preoperatively. A larger heart valvular vegetation size was a risk factor for both symptomatic and silent CVCs; Staphylococcus aureus etiology conferred a higher risk for symptomatic cerebral complication only. Conclusions. @nbsp; The use of sensitive methods of detection indicates that the incidence of CVC associated with infective endocarditis is high, but the risk for neurological deterioration during cardiac surgery after a CVC is lower than previously assumed. The major mechanism behind cerebral complications associated with infective endocarditis is cerebral embolization, although the dominant neurological symptoms vary considerably.

Warfarin therapy and incidence of cerebrovascular complications in left-sided native valve endocarditis

“…Ischemic stroke with focal neurological symptoms is the most frequently reported cerebral complication in IE but also well-documented are more complex syndromes with varying combinations of focal neurological signs, meningism and encephalopathy in the same patient as well as silent cerebral embolism [5,14,24,25]. Autopsy data have indicated that embolic meningoencephalitis is the fundamental neuropathological change in IE [26] and a continuum between vascular and infectious cerebral complications in endocarditis has been suggested [27,28] Staphylococcus aureus aetiology was a major risk factor for CVC in our study as has been shown previously [22].…”

“…More recent studies addressing cerebral events in IE show that hemorrhagic complications are relatively rare in both NVE and PVE [13][14][15] but carry a risk of excess mortality.…”

Imaging modalities in infective endocarditis – state of the art for 2016

“…Na podstawie badań stwierdzono, że zmiany w mózgu (częściej klinicznie nieme) występują u 60-80% pacjentów [16]. MRI jest dobrym narzędziem do wykrywania powikłań IZW o etiologii zatorowej, zwłaszcza tych zlokalizowanych w centralnym układzie nerwowym.…”

“…Dostępne dane literaturowe wskazują, że zmiany w OUN u chorych na IZW występują w 82% przypadków, przy czym subkliniczne incydenty u 30-40% z nich. W jednym z badań wykazano, że u 32% chorych udało się ostatecznie postawić rozpoznanie IZW a u 18% pacjentów wynik MRI miał wpływ na zmianę stosowanego postępowania terapeutycznego [16,17,18]. W przypadku obecności objawów neurologicznych MRI umożliwia dokładniejszą ocenę zmian, natomiast w przypadku braku objawów wpływa na rozpoznanie IZW (małe kryterium diagnostyczne IZW ESC 2015).…”

Difficulties in the treatment of infective endocarditis of unknown aetiology complicated by haemorrhagic stroke, cerebellum stroke, and spleen abscesses

“…The number of detectable neurological complications of infective endocarditis (IE) has been increasing in recent years and is estimated at 40-50%, about 30% of them being detected incidentally as a result of greater availability of diagnostic imaging of central nervous system (CNS) [1][2][3]. About 90% of embolisms affect the brain area that receives a blood supply from the middle cerebral artery [4].…”