[Neurologic manifestations of infective endocarditis: a diagnostic and prognostic challenge].
BACKGROUND
Infective endocarditis (IE) is an ongoing challenge in terms of excess morbidity and mortality. Neurologic complications occur in 20-40% of patients, and the brain is the main location of IE extracardiac complications.


OBJECTIVE
To analyse clinical characteristics of the neurologic complications found in patients with IE, focused on the diagnostic and prognostic aspects.


METHODS
We studied retrospectively the cases of patients with IE admitted to the Hospital de Valme and Hospital de la Merced between 1998 and 2003. Laterly, patients with and without neurologic manifestations were compared. Sixty episodes of IE were evaluated.


RESULTS
Neurological complications occurred in 12 patients (20%). The most frequent neurologic manifestation was unilateral hemi paresis, which occurred in seven cases (58.3%), three cases with acute confusional state (25%) and two patients developed meningitis (16.6%). Brain infarction was the most common lesion found in neuroimaging, in 6 patients (50%), followed by 2 cases (16.6%) of brain hemorrhage, and without significant findings in the cases left. Cases with neurologic complications had significantly higher mortality (p < 0.001) and higher frequency of negative blood culture (p < 0.001).


CONCLUSIONS
Neurologic complications of IE are frequent during the evolution of the disease, and they still constitute a significant problem in clinical practice because they often are not accurately diagnosed and significantly increase patients' mortality.
Castilla-Guerra
L
L
Servicio de Medicina Interna, Hospital de la Merced, Osuna, Sevilla, Spain. castillafernandez@hotmail.com
Fernández-Moreno
M C
MC
Fernández-Bolanos Porras
R
R
López-Chozas
J M
JM
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D011379:Prognosis; D012189:Retrospective Studies