title: Successful cardic surgery 24 hours after craniotomy in a patient with infective endocarditis and embolic cerebellar infarction: case report.
abstract: Follow up management in a patient already treated with decompressive craniotomy for a space-occupying endocarditic stroke is difficult. While immediate valve replacement eliminates the focus and therefore the high risk of re-embolization, a neurosurgical intervention is considered a contraindication to early cardiosurgery. Herein, the first report is presented of a critically ill patient with bacterial endocarditis and a space-occupying cerebellar infarction with imminent herniation, who successfully underwent mitral valve replacement only 24 h after decompressive craniotomy. To prevent rebleeding, maximal hemostasis was ensured during the neurosurgical intervention. For cardiosurgery, the patient was cooled to 21 degrees C, mildly hyperventilated, and maintained at an adequate perfusion pressure during cardiopulmonary bypass. A bioprosthesis was used to reduce the time of anticoagulation. The patient did not develop new infarcts after either intervention, and there was only a very small hemorrhagic transformation without a relevant mass effect. At five months after surgery the patient had minimal neurological abnormalities and was able to conduct his daily life without help.
authors.affiliation: Department of Neurology, Neurological Intensive Care Unit, Ludwigs-Maximilian University, Munich, Germany.
authors.forename: Tobias A
authors.initials: TA
authors.lastname: Rupprecht
authors.forename: Sabine
authors.initials: S
authors.lastname: Weil
authors.forename: Peter A
authors.initials: PA
authors.lastname: Winkler
authors.forename: Eckart
authors.initials: E
authors.lastname: Kreuzer
authors.forename: Hans-Walter
authors.initials: HW
authors.lastname: Pfister
mesh_terms: D020520:Brain Infarction / Q000175:diagnosis / Q000601:surgery*; D002526:Cerebellar Diseases / Q000175:diagnosis / Q000601:surgery*; D003399:Craniotomy; D017548:Echocardiography, Transesophageal; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D020766:Intracranial Embolism / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery*; D012086:Reoperation; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery*; D013997:Time Factors; D014057:Tomography, X-Ray Computed