title: Neurological outcome of septic cardioembolic stroke after infective endocarditis.
abstract: OBJECTIVE
  The aim of this study was to evaluate mortality and neurological outcomes of cardioembolic cerebral stroke in infective endocarditis (IE) patients requiring cardiac surgery.
  
  
  METHODS
  A consecutive series of 214 patients undergoing cardiac surgery for IE was followed up for 20 years. In 65 patients (mean age, 52 years), IE was complicated by computed tomography- or magnetic resonance imaging-verified stroke (n=61) or transient ischemic attack (n=4). Perioperative (30-day) and long-term mortality was assessed with regression models adjusting for age. Complete neurological recovery of IE survivors was defined by a modified Rankin score of < or = 1 and a Barthel index of 20 points.
  
  
  RESULTS
  Fifty of 61 stroke patients (81.9%) survived surgery. In comparison with nonstroke patients, the age-adjusted perioperative mortality risk was 1.70-fold (95% CI, 0.73 to 3.96, P=0.22) higher and long-term mortality risk was 1.23-fold (95% CI, 0.72 to 2.11, P=0.45) higher in stroke patients. Patients with complicated stroke (meningitis, hemorrhage, or brain abscess) showed a higher perioperative mortality rate (38.9% vs 8.5%, P=0.007) but no higher neurological complication rate than patients with uncomplicated ischemic stroke. Complete neurological recovery was achieved in 35 IE survivors (70%, 95% CI, 55% to 82%). However, in the case of middle cerebral artery stroke, recovery was only 50% and was significantly lower compared with non-middle cerebral artery stroke (P=0.012).
  
  
  CONCLUSIONS
  Uncomplicated IE-related stroke showed a favorable prognosis with regard to both long-term survival and neurological recovery. The formidable risk of secondary cerebral hemorrhage due to cardiac surgery seems to be much lower than previously thought.
authors.affiliation: Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. elfriede.ruttmann@uibk.ac.at
authors.forename: Elfriede
authors.initials: E
authors.lastname: Ruttmann
authors.forename: Johann
authors.initials: J
authors.lastname: Willeit
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Orest
authors.initials: O
authors.lastname: Chevtchik
authors.forename: Daniel
authors.initials: D
authors.lastname: Höfer
authors.forename: Werner
authors.initials: W
authors.lastname: Poewe
authors.forename: Günther
authors.initials: G
authors.lastname: Laufer
authors.forename: Ludwig C
authors.initials: LC
authors.lastname: Müller
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000150:complications; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D002543:Cerebral Hemorrhage / Q000209:etiology; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism / Q000150:complications* / Q000453:epidemiology / Q000209:etiology; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009420:Nervous System / Q000503:physiopathology*; D020127:Recovery of Function; D020521:Stroke / Q000175:diagnosis / Q000209:etiology / Q000401:mortality* / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome