Recurrent Acute Ischemic Stroke after Infective Endocarditis Caused by Streptococcus Constellatus : First Case Report and Analysis of the Case Series

Wang, Yumin; Zhao, Weili; Li, Guoli; Peng, Bin; Wang, Hongquan

doi:10.1016/j.jstrokecerebrovasdis.2018.03.021

Cited by 4 publications

(3 citation statements)

References 56 publications

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“…IE is most commonly associated with multiple punctuate, medium or small sized, ischemic lesions with a high tendency for hemorrhagic transformation in multiple arterial territories . Early recurrence due to ongoing septic cerebral embolization has been reported . Factors associated with the highest risk of embolization are vegetation size >10 mm and mitral valve involvement, in particular vegetations attached to the anterior rather than the posterior mitral leaflet …”

Section: Cardiac Sourcesmentioning

confidence: 99%

“…114 Early recurrence due to ongoing septic cerebral embolization has been reported. 115,116 Factors associated with the highest risk of embolization are vegetation size >10 mm and mitral valve involvement, in particular vegetations attached to the anterior rather than the posterior mitral leaflet. 117 TCD monitoring detects MES with a high prevalence in cases with IE.…”

Section: Infective Endocarditismentioning

confidence: 99%

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The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

Kargiotis

Psychogios

Safouris

et al. 2019

Journal of Neuroimaging

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Acute multi‐territory, embolic cerebral infarctions are often associated with serious underlying clinical conditions including the presence of highly “active” emboligenic sources causing that in turn may result in high early recurrence rates. Prompt diagnosis, risk stratification, and treatment are substantial for the prevention of subsequent embolization that would result in further clinical deterioration. Among other clinical investigations, transcranial Doppler (TCD) monitoring is highly efficacious for the detection of microembolic signals (MES) that correspond to microthrombi entering the intracranial circulation. The presence and burden of MES, especially in multiple intracranial arteries, is clearly associated with an increased risk of symptomatic, recurrent embolization, and thus can justify a more aggressive treatment approach (clopidogrel load followed by dual antiplatelet therapy or alternatively therapeutic dose of low‐molecular‐weight heparin). In this narrative review, we discuss the most important causes of multi‐territory embolic ischemic strokes and also underscore the utility of TCD as a noninvasive tool for the diagnosis, risk stratification, and treatment.

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Section: Cardiac Sourcesmentioning

confidence: 99%

Section: Infective Endocarditismentioning

confidence: 99%

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

Kargiotis

Psychogios

Safouris

et al. 2019

Journal of Neuroimaging

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“…Infective endocarditis (IE) has an incidence of 3‐9 per 100 000 in developed countries and is 2.5 times more common in men than women . Stroke is the commonest neurological complication of IE and complicates 20%‐40% of all cases . Stroke can present as the primary manifestation of IE and the risk remains high for recurrence several months following the diagnosis .…”

Section: Introductionmentioning

confidence: 99%

The management of infective endocarditis complicated by stroke

2020

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Transcranial Doppler Emboli Monitoring for Infective Endocarditis

Huang

Johnson

Peacock

et al. 2020

Journal of Neuroimaging

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BACKGROUND AND PURPOSEIschemic stroke can occur in 20‐55% of patients with infective endocarditis (IE) with 75% occurring during the first 2 weeks of treatment. CT or MRI brain can diagnose the sequelae of stroke but transcranial Doppler (TCD) can document active embolization. We undertook a retrospective review of our patient cohort and a systematic review of literature to assess the role of TCD in early diagnosis and management of ischemic stroke in IE.METHODSRetrospective chart review and literature review.RESULTSWe found 89 patients with stroke caused by IE at our institution from December 2011 to April 2018. TCDs were obtained on 26 patients; 16 were abnormal for cerebrovascular abnormalities. Only 4 patients had 30‐minute emboli monitoring performed, of which one revealed emboli. We found 3 studies investigating the role of TCDs in IE that showed promise in its use as a predictive tool in stroke risk stratification.CONCLUSIONSPresence of embolization in the form of high‐intensity transient signals (HITS) detected on TCDs can be used for early diagnosis of IE, assessing efficacy of antibiotic therapy, and stratification of stroke risk in IE. This can aid further research into testing preventative interventions for reducing stroke burden in IE such as earlier valvular surgery or vacuum‐assisted vegetation extraction.

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Recurrent Acute Ischemic Stroke after Infective Endocarditis Caused by Streptococcus Constellatus : First Case Report and Analysis of the Case Series

Cited by 4 publications

References 56 publications

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

The Role of Transcranial Doppler Monitoring in Patients with Multi‐Territory Acute Embolic Strokes: A Review

The management of infective endocarditis complicated by stroke

Transcranial Doppler Emboli Monitoring for Infective Endocarditis

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