title: Neurologic manifestations as presenting symptoms of endocarditis.
abstract: The features of infective endocarditis include both cardiac and non-cardiac manifestations. Neurologic complications are seen in up to 40% of patients with infective endocarditis and are the presenting symptom in a substantial percentage. We describe in detail the clinical scenarios of three patients admitted to our hospital, compare their characteristics and review the recent literature describing neurologic manifestations of infective endocarditis. Our patients demonstrate that infective endocarditis can develop without comorbidity or a valvular defect. Moreover, our patients were young and lacked the most common symptom of endocarditis: fever. The most common neurologic manifestations were focal neurologic deficits and confusion. We conclude that infective endocarditis should always be considered in patients presenting with new-onset neurologic complaints, especially in those without comorbidities or other risk factors. A prompt diagnosis should be reached and antibiotic treatment initiated as soon as possible.
authors.affiliation: Department of Medicine, Meir Medical Center, Kfar Saba, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
authors.forename: Adaya
authors.initials: A
authors.lastname: Weissler
authors.forename: Leor
authors.initials: L
authors.lastname: Perl
authors.forename: Yoram
authors.initials: Y
authors.lastname: Neuman
authors.forename: Yoseph A
authors.initials: YA
authors.lastname: Mekori
authors.forename: Adam
authors.initials: A
authors.lastname: Mor
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D020520:Brain Infarction / Q000175:diagnosis / Q000209:etiology; D002545:Brain Ischemia / Q000175:diagnosis / Q000209:etiology; D003221:Confusion / Q000209:etiology; D003937:Diagnosis, Differential; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D006261:Headache / Q000175:diagnosis / Q000209:etiology; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology*; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents