Neurologic complications of endocarditis

Abstract

We reviewed the neurologic complications in 113 patients with native and 62 patients with prosthetic valve endocarditis. Neurologic complications occurred with the same frequency (35.3% vs 38.7%) and distribution among the two groups. Death occurred in 20.6% of patients with neurologic complications and in 13.6% of patients without neurologic complications (p = 0.23). Staphylococcus aureus endocarditis correlated statistically with the development of neurologic complications (p less than 0.01) and death (p less than 0.01). Among 50 patients discharged from the hospital after receiving only medical treatment for native valve endocarditis, and followed for a mean period of 48 months, there was one patient with mitral valve prolapse and stroke. We conclude that (1) neurologic complications occur with the same frequency in native and prosthetic valve endocarditis, (2) S aureus endocarditis increases the risk of neurologic complications and death, (3) mortality is not significantly increased in patients with neurologic complications, and (4) an episode of treated native valve endocarditis does not increase the natural history of stroke in valvular disease.

Neurological Complications of Infective Endocarditis

“…Aortic valve disease in our patients was more associated with neurological complications, and this differs from other studies that showed a linkage between mitral valve disease and increased risk of cerebral embolism. 8 Streptococcal species was the most common organism seen in the NC group but was also common in the NNC and is comparable to previous studies. 9 Some reports suggest that Staphylococcus aureus is more associated with neurological complications, particularly thromboembolism.…”

“…9 Some reports suggest that Staphylococcus aureus is more associated with neurological complications, particularly thromboembolism. 3,6,8 Culture negative and brucella endocarditis were less associated with NC in our studies.…”

“…1,3,8 Some increase was noted compared to the studies before the pre-antibiotic era, and this may reflect the improved survival rate in patients with IE with antibiotic cover and early surgical intervention as needed, so neurological complications have more time to appear. Aortic valve disease in our patients was more associated with neurological complications, and this differs from other studies that showed a linkage between mitral valve disease and increased risk of cerebral embolism.…”

Significance of the T2*-weighted gradient echo brain imaging in patients with infective endocarditis

“…Intracranial IAs are less common (2-4% of endocarditis cases) but they produce potentially devastating neurological complications such as intracerebral or subarachnoid hemorrhage [9][10][11]. Since IAs can be clinically silent and some of them could resolve by antibiotic therapy, actual incidence of IAs is considered to be higher than the ones reported in the literatures [12].…”

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

“…The most common neurological complication is cerebral stroke, while encephalopathy, central retinal artery blockage, mycotic aneurysms, abscesses, meningitis, and seizures occur less frequently [5,6]. The following factors predispose to neurological complications of IE: heart failure, arrhythmias, abnormal atrioventricular conduction, and the presence of suppurative lesions [4].…”