Infective Endocarditis with Symptomatic Cerebral Complications: Contribution of Cerebral Magnetic Resonance Imaging

Goulenok, Tiphaine; Klein, Isabelle; Mazighi, Mikaël; Messika–Zeitoun, David; Alexandra, J.F.; Mourvillier, Bruno; Laissy, Jean-Pierre; Leport, Catherine; Iung, Bernard; Duval, Xavier

doi:10.1159/000348317

Cited by 73 publications

(55 citation statements)

References 25 publications

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“…In summary, the clinical signs and symptoms of patients with ICMA are diverse and can occur commonly in patients with IE or other CNS 127,128,[142][143][144][145][146][147] infections who do not have ICMA. Accordingly, any patient with these underlying predisposing conditions who develops severe, localized, unremitting headache; focal neurological findings; stroke; or acute intracerebral or subarachnoid hemorrhage should be suspected of having ICMA.…”

Section: E430mentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

355

307

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The use of synthetic material for reconstructive vascular surgery was first reported during the early 1950s. Infection involving vascular graft prostheses is an infrequent but devastating complication of reconstructive vascular graft surgery and is associated with a high morbidity and, in some situations, mortality. Improvements in surgical techniques and graft design, including the use of native venous or arterial tissue, have reduced the frequency of infection and severity of complications from vascular graft infection (VGI). However, these advances have also led to more frequent vascular graft procedures occurring in a patient population with multiple underlying comorbidities that would have previously disqualified them as candidates for vascular reconstructive surgery. Underlying comorbidities, such as diabetes mellitus or immune compromise, increase the risk of infection and serious infection-related complications. The major complications of VGI include sepsis, amputation, disruption of infected anastomotic suture line with rupture or pseudoaneurysm formation, embolization of infected thrombi, reinfection of reconstructed vascular grafts, enteric fistulae to the small or large bowel, bacteremic spread of infection to other sites, and death. VGIs can be categorized broadly into those that occur in an extracavitary location, primarily in the groin or lower extremities, or in an intracavitary location, primarily within the abdomen or less commonly within the thorax. frequencyThe frequency of VGI depends on the anatomic location of the graft. The infection rate is 1.5% to 2% for most extracavitary grafts and as high as 6% with vascular grafts in the groin. [1][2][3][4][5][6][7][8][9] For intracavitary grafts, the infection rate is ≈1% to 5%. 1-6 Graft infection is most common after emergency procedures and after reoperation. [1][2][3][4]10 Aortic graft erosion or fistulous communication into the duodenum or other areas of the bowel reportedly occurs in 1% to 2% of patients after aortic reconstruction. 11,12 MicrobiologyThe microbiological cause of VGI has evolved over the years. 1 In early published studies, Staphylococcus aureus was the predominant microorganism recovered. 1,13 Improvements in surgical technique, administration of prophylactic antistaphylococcal antimicrobial therapy, and other factors have resulted in a changing microbiological epidemiology. Vascular graft surgery performed on patients with multiple underlying comorbidities and the increased frequency of emergency procedures have contributed to the changing spectrum of infection. Other factors such as changes in hospital flora, surgery in patients with complicated vascular anatomy, and multiple revisions of previous vascular surgery have resulted in a more diverse microbio- clInIcal stateMents anD GuIDelInes logical spectrum of infection, which includes multidrugresistant strains, polymicrobial infection, and Candida species. Gram-positive cocci accounts for at least two thirds of VGIs. 1,13 Infections caused by coagulase-negative staphylococ...

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Section: E430mentioning

confidence: 99%

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Wilson¹,

Bower²,

Creager³

et al. 2016

Circulation

355

307

View full text Add to dashboard Cite

show abstract

“…U większości pacjentów z objawami neurologicznymi w MRI mózgu znajduje się nieprawidłowości [89]. MRI cechuje się wyższą czułością w porównaniu z CT w diagnostyce opisywanych zmian, szczególnie w odniesieniu do udarów, napadów przemijającego niedokrwienia mózgu i encefalopatii.…”

Section: Obrazowanie Metodą Rezonansu Magnetycznegounclassified

“…W MRI można stwierdzić również dodatkowe zmiany w mózgu, niezwiązane z objawami klinicznymi. MRI mózgu nie wpływa na rozpoznanie IZW u pacjentów z objawami neurologicznymi, gdyż spełniają oni jedno małe kryterium Duke, ale może wpłynąć na postępowanie terapeutyczne, szczególnie czas leczenia chirurgicznego [89]. Wśród pacjentów bez objawów neurologicznych przynajmniej u połowy stwierdza się zmiany w mózgu, głównie o charakterze niedokrwiennym [90].…”

Section: Obrazowanie Metodą Rezonansu Magnetycznegounclassified

“…Wyższa czułość MRI z użyciem lub bez wzmocnienia kontrastowego gadolinium pozwala na lepszą ocenę uszkodzeń mózgu u pacjentów z objawami neurologicznymi, co może wpłynąć na wybrany czas leczenia chirurgicznego [89] (patrz rozdział 5.). U pacjentów bez objawów neurologicznych MRI mózgu często uwidacznia uszkodzenia, co może zmienić podejście terapeutyczne, w szczególności wskazania i czas leczenia chirurgicznego [85,90].…”

Section: Wskazania I Tryb Leczenia Operacyjnego W Celu Zapobiegania Zunclassified

“…W MRI mózgu u pacjentów z IZW często uwidacznia się mikrokrwawienia (ogniska hipodensyjne w obrazach T2* o średnicy ≤ 10 mm). Brak związku z krwawieniami śródmiąższowymi i brak pooperacyjnych powikłań neurologicznych u pacjentów z mikrokrwawieniami sugerują, że nie powinny być one interpretowane jako aktywne krwawienia, a ich obecność nie powinna opóźniać leczenia chirurgicznego, jeśli istnieją wskazania [89,90].…”

Section: Wskazania I Tryb Leczenia Operacyjnego W Celu Zapobiegania Zunclassified

See 2 more Smart Citations

2015 ESC Guidelines for the management of infective endocarditis

Habib¹,

Lancellotti

Antunes³

et al. 2015

Kardiol Pol

144

212

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Preoperative Cerebrovascular Evaluation in Patients With Infective Endocarditis

Behrouz

2015

Clinical Cardiology

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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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Infective Endocarditis with Symptomatic Cerebral Complications: Contribution of Cerebral Magnetic Resonance Imaging

Cited by 73 publications

References 25 publications

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

2015 ESC Guidelines for the management of infective endocarditis

Preoperative Cerebrovascular Evaluation in Patients With Infective Endocarditis

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