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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 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. |
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anticoagulant,treatment
bacterial endocarditis,neurologic manifestations of
cerebral embolism
cerebral embolism,cardiac origin
cerebrovascular accident
cerebrovascular accident,recurrent
drug abuse
drug abuse,neurologic complications of
echocardiogram
embolism
endocarditis
endocarditis,acute bacterial
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intracerebral hemorrhage
intracranial hemorrhage
mortality
mycotic aneurysm
prognosis
review article
treatment of neurologic disorder
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