Fatal cerebroembolism from nonbacterial thrombotic endocarditis in a trauma patient: case report and review.
Nonbacterial thrombotic endocarditis (NBTE) is a rare condition that may result in an unexpected and usually fatal cerebroembolism. It occurs in a variety of clinical situations, including malignancy, immune disorders, and sepsis, but it has rarely been reported after trauma. The formation of NBTE appears to require a hypercoagulable state and changes in valvular morphology, e.g., during a hyperdynamic state. Patients with disseminated intravascular coagulation have a 21% incidence of NBTE. Although NBTE is usually found at autopsy, premorbid detection by echocardiography is currently possible and feasible. Untreated patients have a high incidence of embolic events, but anticoagulation with heparin may be life-saving. A lethal case of NBTE in a severely injured patient is reported here with the purpose of increasing awareness among medical personnel caring for trauma patients. Recommendations have been made for surveillance echocardiography in high-risk patients, e.g., critically ill patients with sepsis or disseminated intravascular coagulation.
Sharma
S
S
Department of Surgery, Oregon Health Sciences University, Portland 97201-3098, USA.
Mayberry
J C
JC
Deloughery
T G
TG
Mullins
R J
RJ
D000328:Adult; D001926:Brain Death; D004211:Disseminated Intravascular Coagulation / Q000150:complications; D004696:Endocarditis / Q000150:complications*; D017809:Fatal Outcome; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology; D020766:Intracranial Embolism / Q000209:etiology*; D008297:Male; D009104:Multiple Trauma / Q000150:complications*; D018805:Sepsis / Q000150:complications; D019851:Thrombophilia / Q000150:complications; D013927:Thrombosis / Q000150:complications*