title: Cerebrovascular complications in patients with left-sided infective endocarditis are common: a prospective study using magnetic resonance imaging and neurochemical brain damage markers.
abstract: Background. @nbsp; Cerebrovascular complications (CVCs) have remained a major therapeutic and prognostic challenge associated with infective endocarditis, and definite risk factors have not been fully elucidated. This prospective study was designed to the evaluate the total incidence of CVC associated with infective endocarditis and major risk factors. Methods. @nbsp; During 2 study periods, from June 1998 through April 2001 and from September 2002 through January 2005, patients were prospectively enrolled in the study regardless of neurological symptoms. Study patients underwent neurological examinations and magnetic resonance imaging of the brain, and cerebrospinal fluid analyses of inflammatory and neurochemical markers of brain damage (neurofilament protein and glial fibrillary acidic protein) were performed. Results. @nbsp; Sixty patients who experienced episodes of left-sided infective endocarditis were evaluated; 35% of these patients experienced a symptomatic CVC. Silent cerebral complications were detected in another 30% of the patients, and the total CVC rate was 65% (95% confidence interval, 58%-72%). Five percent of patients experienced their first neurological symptom after the initiation of antibiotic treatment without prior surgery. No new symptomatic CVCs were detected after 10 days of antibiotic treatment. No neurological deterioration was observed after surgery in patients who were established to have a symptomatic CVC preoperatively. A larger heart valvular vegetation size was a risk factor for both symptomatic and silent CVCs; Staphylococcus aureus etiology conferred a higher risk for symptomatic cerebral complication only. Conclusions. @nbsp; The use of sensitive methods of detection indicates that the incidence of CVC associated with infective endocarditis is high, but the risk for neurological deterioration during cardiac surgery after a CVC is lower than previously assumed. The major mechanism behind cerebral complications associated with infective endocarditis is cerebral embolization, although the dominant neurological symptoms vary considerably.
authors.affiliation: Departments of 1Infectious Diseases, 2Radiology, and 3Neurology, Sahlgrenska University Hospital, Göteborg, and Departments of 4Infectious Diseases and 5Radiology, and 6Research and Development Center, Skaraborg Hospital, Skövde, Sweden.
authors.forename: Ulrika
authors.initials: U
authors.lastname: Snygg-Martin
authors.forename: Lars
authors.initials: L
authors.lastname: Gustafsson
authors.forename: Lars
authors.initials: L
authors.lastname: Rosengren
authors.forename: Asa
authors.initials: A
authors.lastname: Alsiö
authors.forename: Per
authors.initials: P
authors.lastname: Ackerholm
authors.forename: Rune
authors.initials: R
authors.lastname: Andersson
authors.forename: Lars
authors.initials: L
authors.lastname: Olaison
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging; D001927:Brain Diseases / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D002555:Cerebrospinal Fluid / Q000737:chemistry / Q000276:immunology; D004696:Endocarditis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D005260:Female; D005904:Glial Fibrillary Acidic Protein / Q000134:cerebrospinal fluid; D006351:Heart Valves / Q000382:microbiology; D006801:Humans; D015994:Incidence; D020766:Intracranial Embolism; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016900:Neurofilament Proteins / Q000134:cerebrospinal fluid; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000150:complications / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification
chemical_list: D000900:Anti-Bacterial Agents; D005904:Glial Fibrillary Acidic Protein; D016900:Neurofilament Proteins