Stroke in infective endocarditis.

Abstract

We reviewed 212 consecutive episodes of infective endocarditis in 203 patients at six hospitals between 1978 and 1986 and found that 21% were complicated by stroke. Of 133 episodes involving native mitral and/or aortic valves, brain ischemia occurred in 19%, brain hemorrhage in 7%, and non-central nervous system emboli in 11%; vegetations were identified in 56% of 113 adequate echocardiograms and did not correlate with risk of embolism. In native-valve endocarditis, most (74%) ischemic strokes had occurred by the time of presentation and an additional 13% occurred <48 hours after diagnosis; the incidence of brain ischemia was 13% on presentation, 3% during the first 48 hours of hospitalization, and 2%-5% during the remainder of the acute course. Stroke recurred at a rate of 0.5%/day, often heralding relapse/uncontrolled infection. Only 9% of ischemic infarcts were large (all in patients with Staphylococcus aureus infection), while 8% were small and subcortical. Brain hemorrhage occurred primarily at the time of presentation, particularly in intravenous drug abusers, and was associated with uncontrolled S. aureus infection with pyogenic arteritis. Ischemic and hemorrhagic stroke continue to be frequent and important in patients with infective endocarditis and are clustered during uncontrolled infection. Patients with infective endocarditis and ischemic stroke on presentation seldom had recurrent emboli after the infection was controlled; anticoagulants and surgery are not warranted to prevent recurrent stroke in these patients. Symptomatic mycotic aneurysms are quite uncommon. (Stroke 1990:21:695-700)

Association Between Surgical Indications, Operative Risk, and Clinical Outcome in Infective Endocarditis

“…Stroke before surgical decision was also inversely associated with surgery during the index hospitalization, likely reflecting the uncertain timing and safety of surgery in patients with IE complicated by stroke. [30][31][32][33] The majority of stroke in IE occurs at the time of presentation, 34 before or soon after the initiation of antibiotic therapy. 35 Nearly one half of strokes in patients who did not have surgery despite an indication were hemorrhagic.…”

Role of routine transthoracic echocardiography in evaluation and management of stroke

“…The data with regards to recurrent stroke in endocarditis are also sparse, and have not been stratified by age. Cerebrovascular ischemia occurs prior to diagnosis in 14-42% of patients with leftsided endocarditis and visible vegetations on echo [38][39][40], with a pooled estimate of 21%. There is a rapid decline in stroke rate after initiation of antibiotics, with a wide range of estimates from four events per 1000 patient days [41], to 4.3% in the first 48 h [38], to 4.8% over the next month [38].…”

Septik Pulmoner Emboli, Olgu Sunumu

“…Önceden var olan kalp hastalığı, bakteriyemi oluşumu ve enfektif endokarditin ortaya çıkışı arasındaki bağlantı çok eski yıllardan beri bilinmektedir [5]. Bakteriyemiler yalnızca diş çekimi, tonsillektomi ve bronkoskopi gibi büyük girişimlerden sonra değil, diş fırçala-ma esnasında bile oluşabilir ve SPE' ye yol aça-bilir [6]. Bizim olgumuzda, septik emboli nedeni olarak diş absesi sebebi ile diş çekim öyküsü saptandı fakat yapılan ekokardiyografik değerlen-dirmesinde kapaklarda vejetesyon olmadığı için enfektif endokardit ekarte edildi.…”