Mechanisms of intracranial hemorrhage in infective endocarditis.
Analysis of 17 patients with infective endocarditis and intracranial hemorrhage yielded several different mechanisms of bleeding. Nine of 15 (60%) symptomatic intracranial hemorrhages occurred within 48 hours of admission and 3 more (20%) after hospital discharge. In 7 patients with Staphylococcus aureus endocarditis, symptomatic intracranial hemorrhage occurred within 48 hours of admission and resulted from septic arteritis in all 3 examined pathologically. Secondary hemorrhagic transformation (hemorrhagic infarction) was asymptomatic in 2 nonanticoagulated patients but was associated with clinical worsening in 2 anticoagulated patients. Anticoagulation potentially contributed to intracranial hemorrhage in 4 of the 17 patients (24%). Proven mycotic aneurysms were present in only 2 patients (12%), 1 of whom presented with massive, fatal intracranial hemorrhage. Mycotic aneurysms amenable to surgery are uncommon and underlie only a fraction of intracranial hemorrhages in infective endocarditis.
Department of Medicine (Neurology), University of Texas Health Science Center, San Antonio 78284.
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Hart
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Kagan-Hallet
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Joerns
D000328:Adult; D000368:Aged; D000785:Aneurysm, Infected / Q000150:complications; D000925:Anticoagulants / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000209:etiology*; D004697:Endocarditis, Bacterial / Q000150:complications*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000150:complications*; D013290:Streptococcal Infections / Q000150:complications*; D019966:Substance-Related Disorders / Q000150:complications; D013997:Time Factors
D000925:Anticoagulants