Focal neurologic deficits in infective endocarditis and other septic diseases.
BACKGROUND
Focal neurologic deficits in sepsis frequently result from parenchymal lesions due to cerebral embolism. The aim of this study was to characterize clinical, laboratory and radiologic patterns of those patients.


METHODS
Medical records of 30 patients with focal neurologic symptoms during sepsis were analyzed retrospectively.


RESULTS
24 patients (22 with infective endocarditis) had ischemic stroke. Cerebrospinal fluid (CSF) analyses revealed inflammation in 11 of 12 patients. Patients who died (11/24) suffered more frequently from secondary intracerebral hemorrhage (p = 0.0031), which was significantly associated with intravenous high-dose anticoagulation (p = 0.0059). Six patients had slowly progressive focal neurologic deficits without evidence for stroke. All showed CSF inflammation and three developed multiple cerebral abscesses.


CONCLUSIONS
There are two distinctive groups of patients with focal neurologic deficits during sepsis. One presents with stroke and CNS inflammation (septic embolic focal encephalitis). The other group develops slowly progressive focal neurologic deficits and sometimes multiple cerebral abscesses (septic metastatic focal encephalitis).
Bitsch
A
A
Department of Neurology, Georg-August University Göttingen, Germany.
Nau
R
R
Hilgers
R A
RA
Verheggen
R
R
Werner
G
G
Prange
H W
HW
D000328:Adult; D000368:Aged; D001922:Brain Abscess / Q000134:cerebrospinal fluid / Q000382:microbiology / Q000503:physiopathology; D002545:Brain Ischemia / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology; D004696:Endocarditis / Q000150:complications* / Q000382:microbiology*; D016983:Enterococcus / Q000302:isolation & purification; D005260:Female; D006801:Humans; D007709:Klebsiella / Q000302:isolation & purification; D008297:Male; D008837:Micrococcus / Q000302:isolation & purification; D008875:Middle Aged; D012189:Retrospective Studies; D013210:Staphylococcus / Q000302:isolation & purification; D013291:Streptococcus / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed