Neurologic Complications of Infective Endocarditis

Lerner, Phillip I.

doi:10.1016/s0025-7125(16)31050-1

Cited by 86 publications

(39 citation statements)

References 34 publications

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“…Among patients with unruptured ICMAs, the mortality rate is 30%; in patients with ruptured ICMAs, the mortality rate approaches 80%. 264,265 The reported occurrence of ICMAs in 1.2% to 5% of cases [265][266][267][268] is probably underestimated because some ICMAs remain asymptomatic and resolve with antimicrobial therapy. Streptococci and S aureus account for Ϸ50% and Ϸ10% of cases, respectively, 256,268 and are seen with increased frequency among IDUs with IE.…”

Section: Intracranial Masmentioning

confidence: 99%

Infective Endocarditis

Baddour¹,

Wilson²,

Bayer³

et al. 2005

Circulation

1,274

436

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Background-Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness. Methods and Results-This work represents the third iteration of an infective endocarditis "treatment" document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen. Conclusions-The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management. (Circulation. 2005; 111:e394-e433.)

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Section: Intracranial Masmentioning

confidence: 99%

Infective Endocarditis

Baddour¹,

Wilson²,

Bayer³

et al. 2005

Circulation

1,274

436

View full text Add to dashboard Cite

show abstract

“…131 The distal middle cerebral artery branches are most often involved, especially the bifurcations. ICMAs are multiple in 20% of cases 130 ; mortality rates are similar for multiple or single distal ICMAs. The mortality rate for patients with proximal ICMAs exceeds 50%.…”

Section: Mycotic Aneurysmsmentioning

confidence: 96%

“…Among those without rupture, the mortality rate is 30%; this approaches 80% if rupture occurs. 126 The reported occurrence of ICMAs in 1.2% to 5% of cases [127][128][129][130][131] is probably an underestimate because some ICMAs remain asymptomatic and resolve with antimicrobial therapy. Streptococci and S aureus account for Ϸ50% and Ϸ10% of cases, respectively, 124,126,131 and are seen with increased frequency among IVDA patients with IE.…”

Section: Mycotic Aneurysmsmentioning

confidence: 99%

“…Patients may develop severe localized headache, altered sensorium, or focal neurological deficits such as hemianopsia or cranial neuropathies; the neurological signs and symptoms may suggest a mass lesion or an embolic event. 123,124,130 Some ICMAs leak slowly before rupture and produce mild meningeal irritation. Typically, the spinal fluid in these patients is sterile and contains erythrocytes, leukocytes, and elevated protein.…”

Section: Mycotic Aneurysmsmentioning

confidence: 99%

“…133,134 Accordingly, imaging procedures to detect ICMAs are indicated in IE patients with localized or severe headaches, "sterile" meningitis, or focal neurological signs. 123,124,127,130 In patients suspected of having an ICMA, contrast-enhanced CT may provide useful initial information. 135 This technique has a 90% to 95% sensitivity for intracerebral bleed and may thus indirectly identify the location of the MA.…”

Section: Mycotic Aneurysmsmentioning

confidence: 99%

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