title: Incidence of neurological complications in patients with native-valve infective endocarditis and cerebral microembolism: an open cohort study.
abstract: The objective of this open cohort study was to assess the association between neurological complications in patients with definite native-valve infective endocarditis (IE) and cerebral microembolism (MES). MES detection was performed with 1-h, bilateral middle cerebral arteries (MCA) insonation using a transcranial Doppler ultrasound (TCD) machine. Thirty patients with definite native-valve IE were stratified into 2 groups based upon the presence of MES. The most striking difference between the 2 groups of patients was the incidence of clinically evident neurological complications. Neurological complications of IE occurred in 10 (83.3%) patients with positive MES and in 6 (33.3%) MES-negative patients (p=0.021). Ischaemic stroke was the most common complication, occurring in 11 of 16 patients, followed by meningitis in 4 patients and cerebritis in 1 patient. There was a trend towards greater in-hospital mortality in patients with recorded MES than in the MES-negative, although this was not statistically significant (33.3% vs 16.6%; p=0.392). Our results reveal a significant association between MES and neurological complications in patients with native-valve IE. TCD is a promising tool in predicting individual patient risk for neurological complications of IE.
authors.affiliation: Department of Neuroinfections and Intensive Care Medicine, University Hospital for Infectious Diseases Dr. Fran Mihaljević, Zagreb, Croatia. lepurix@inet.hr
authors.forename: Dragan
authors.initials: D
authors.lastname: Lepur
authors.forename: Bruno
authors.initials: B
authors.lastname: Barsić
mesh_terms: D000328:Adult; D000368:Aged; D001922:Brain Abscess / Q000000981:diagnostic imaging / Q000209:etiology; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology; D016009:Chi-Square Distribution; D015331:Cohort Studies; D004696:Endocarditis / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D020766:Intracranial Embolism / Q000150:complications* / Q000000981:diagnostic imaging; D008297:Male; D008581:Meningitis / Q000000981:diagnostic imaging / Q000209:etiology; D008875:Middle Aged; D009422:Nervous System Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D011446:Prospective Studies; D017585:Ultrasonography, Doppler, Transcranial