Neurologic complications of infective endocarditis

Abstract

Neurologic syndromes often complicate the management of infective endocarditis (IE). We retrospectively reviewed 166 episodes of native valve endocarditis to assess the occurrence and implications of nonfocal encephalopathy, meningitis, salient headache, back pain, and brain abscess. Neurologic complications occurred in 35% (58/166) of patients: 41% (54/133) of mitral or aortic valve IE and 12% (4/33) of tricuspid valve IE. Of 133 cases of mitral or aortic valve IE, encephalopathy occurred in 14%, meningitis in 5%, and salient headache in 3%. All neurologic complications occurred more often with Staphylococcus aureus infection (67%) than with viridans streptococci (22%), including encephalopathy (22% versus 7%), meningitis (17% versus 0%), stroke (39% versus 16%), and death (39% versus 9%). Encephalopathy was associated with virulent organisms, increased patient age, and uncontrolled infection. Clinical, radiologic, and neuropathologic data all suggest that infective microemboli are often etiologic in IE-related encephalopathy. There were no macroscopic brain abscesses clinically identified. Meningitis occurred only with virulent organisms. While many clinical aspects of IE have changed in recent years, the frequency and gravity of neurologic complications have not.

Neurological Complications of Infective Endocarditis

“…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.…”

“…2 Intracranial hemorrhage is identified in 5% of cases 6 and cerebral infarctions in 14%-19% 3,5,7 other complications include acute meningitis, brain abscess, encephalopathy, seizures and headache. 1,3,5 Rarely, back pain with root lesion due to intervertebral disc infection or acute mononeuropathy may occur. 1,3 Despite the introduction of potent antimicrobial agents and new diagnostic and therapeutic procedures, the neurological complications remain high.…”

“…1,3 Despite the introduction of potent antimicrobial agents and new diagnostic and therapeutic procedures, the neurological complications remain high. 1,3 We retrospectively reviewed 80 successive patients with IE who were admitted to Riyadh Armed Forces Hospital between 1981-1993, in order to evaluate the frequency, pattern, etiology and prognosis of neurological complications in patients with IE.…”

“…1,3,5 Rarely, back pain with root lesion due to intervertebral disc infection or acute mononeuropathy may occur.…”

Pediatric Endocarditis and Stroke: A Single-Center Retrospective Review of Seven Cases

“…In adults with infective endocarditis, neurological complications develop in 20 -40% of patients [4]. The most frequent neurological complications include cerebral infarction, bacterial meningitis, intracerebral hemorrhage and mycotic aneurysms [5,6].…”