Infective Endocarditis Presenting with Intracranial Bleeding

Abstract

We describe the clinical courses of 3 patients with aortic prosthetic valve IE presenting with ICB. Patients 1 and 2 experienced subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), respectively, caused by rupture of an intracranial infectious aneurysm (IIA). Both underwent endovascular treatment of IIA with good outcome. In patient 3, ICB was the hemorrhagic conversion of an acute ischemic lesion from septic brain embolization. In the subacute phase of the disease, aortic valve replacement was performed, with excellent outcome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ICB is a relevant complication and sometimes the first clinical feature of IE. Imaging of brain vessels should be performed to investigate the pathologic mechanism underlying ICB. The prevalence of IIA is probably underestimated and may influence the therapeutic strategy. Cerebrovascular imaging may therefore also be considered in asymptomatic subjects with left-sided IE. Withdrawal of anticoagulant treatment and delay of cardiac surgery are recommended in all cases of IE complicated by ICB. Because of the impact of ICB on IE management and outcome, a high level of clinical suspicion and prompt recognition and treatment of this complication are necessary.

Intracerebral and Subarachnoid Hemorrhage as a Result of Infective Endocarditis: A Case Report

“…1,3 The pathological mechanism of intracranial bleeding are wide ranging, from the hemorrhagic conversion of infarcted area secondary to septic emboli, rupture of intracranial mycotic aneurysms (ICMA), until microbleeds due to immunologic vasculitis. [8][9][10] SAH in IE is uncommon and only described in case reports. ICMA is classically associated with SAH, however non-aneurysmal spontaneous SAH could happen in a rare cases.…”

Infective Endocarditis Presenting as Subarachnoid Hemorrhage: An Appeal for Caution

“…The pathological mechanisms are wide-ranging. Hemorrhagic conversion of infarcted area secondary to septic emboli is the most common mechanism defined [5]. Another process implicated is rupture of intracranial mycotic aneurysms (ICMA) [6].…”

Neurological complications of infective endocarditis

“…Ряд экспертов констатировали достоверно более высокую летальность в группе пациентов с тромбоэмболиями (39%, p<0,001) по сравнению с таковой у пациентов, у которых данные осложнения не отмечались (9%) [9]. ИЭ может осложниться внутримозговым или субарахноидальным кровоизлияниями, сопровождающимися высокой летальностью [3,11]. Первичное внутримозговое кровоизлияние у больных с ИЭ наблюдается в 2,4% случаев [9] [8].…”