title: Current treatment of active infective endocarditis with brain complications.
abstract: We describe the optimal timing of surgery in active infective endocarditis patients with brain complications. (1) Non-hemorrhagic infarction: elective surgery has been recommended in patients with non-hemorrhagic infarction. However, the timing is changing to an earlier phase. Recent studies have shown that silent brain embolism and small-size infarction (15-20 mm) without coma can be operated safely without delay. On the other hand, in patients with large non-hemorrhagic infarction with impaired consciousness, early surgery is not recommended. (2) Non-ruptured infectious intracranial aneurysm: treatment strategies for patients with infectious aneurysms without rupture remain controversial. However, the treatments are generally as follows. If the intracranial aneurysm without rupture decreases in size by administration of effective antibiotics, neurosurgery will not be required and cardiac surgery can be prioritized without delay. When the aneurysm without rupture enlarges and changes its morphology, neurosurgery or endovascular surgery should be prioritized to prevent its rupture. (3) Hemorrhagic stroke: this type is classified into primary intra-cerebral hemorrhage due to simple necrotic arteritis, hemorrhagic transformation of ischemic infarcts, and rupture of intracranial infectious aneurysms. Among these, primary intracerebral hemorrhage is the most frequently observed. In patients with the primary intracerebral hemorrhage, surgery must be postponed for at least 4 weeks to prevent exacerbation of bleeding. In patients with ruptured infectious aneurysm, neurosurgery or endovascular surgery is performed initially and cardiac surgery should be postponed at least 2-3 weeks.
authors.affiliation: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan, takashiren@yahoo.co.jp.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miura
authors.forename: Kiyoyuki
authors.initials: K
authors.lastname: Eishi
mesh_terms: D000785:Aneurysm, Infected / Q000209:etiology; D017542:Aneurysm, Ruptured / Q000517:prevention & control; D001927:Brain Diseases / Q000209:etiology; D020520:Brain Infarction / Q000209:etiology; D006348:Cardiac Surgical Procedures; D002543:Cerebral Hemorrhage / Q000209:etiology; D004696:Endocarditis / Q000150:complications / Q000601:surgery*; D006801:Humans; D002532:Intracranial Aneurysm / Q000209:etiology; D020766:Intracranial Embolism / Q000209:etiology; D013997:Time Factors
references.citation: Lancet Infect Dis. 2006 Nov;6(11):742-8
references.pmid: 17067923
references.citation: Arch Intern Med. 2000 Oct 9;160(18):2781-7
references.pmid: 11025788
references.citation: Stroke. 2006 Aug;37(8):2094-9
references.pmid: 16794213
references.citation: Brain. 1989 Oct;112 ( Pt 5):1295-315
references.pmid: 2679968
references.citation: Eur Heart J. 2007 May;28(9):1155-61
references.pmid: 17363448
references.citation: J Am Coll Cardiol. 2001 Mar 15;37(4):1069-76
references.pmid: 11263610
references.citation: AJNR Am J Neuroradiol. 1995 Apr;16(4):745-8
references.pmid: 7611032
references.citation: Eur Heart J. 2009 Oct;30(19):2369-413
references.pmid: 19713420
references.citation: Ann Intern Med. 1991 Apr 15;114(8):635-40
references.pmid: 2003709
references.citation: Neurology. 1991 Jul;41(7):1015-20
references.pmid: 1829793
references.citation: Circulation. 2005 Jul 5;112(1):69-75
references.pmid: 15983252
references.citation: Am J Med. 1997 Apr;102(4):379-86
references.pmid: 9217620
references.citation: Neurosurgery. 2002 Nov;51(5):1145-51; discussion 1151-2
references.pmid: 12383359
references.citation: Neurol India. 2000 Sep;48(3):276-8
references.pmid: 11025635
references.citation: Stroke. 1987 Nov-Dec;18(6):1048-56
references.pmid: 3686576
references.citation: Circulation. 2009 Aug 18;120(7):585-91
references.pmid: 19652096
references.citation: Neurol India. 2001 Sep;49(3):262-6
references.pmid: 11593243
references.citation: Heart. 2005 Jul;91(7):932-7
references.pmid: 15958364
references.citation: Med Klin (Munich). 1998 May 15;93(5):284-93
references.pmid: 9630812
references.citation: Ann Thorac Surg. 1996 Apr;61(4):1125-9; discussion 1130
references.pmid: 8607669
references.citation: Neurosurgery. 1984 Jul;15(1):43-9
references.pmid: 6548001
references.citation: Neurology. 1989 Feb;39(2 Pt 1):173-8
references.pmid: 2915785
references.citation: Gen Thorac Cardiovasc Surg. 2011 Jul;59(7):467-71
references.pmid: 21751105
references.citation: Neurosurgery. 2001 Jun;48(6):1203-13; discussion 1213-4
references.pmid: 11383721
references.citation: Stroke. 1992 Nov;23(11):1662-7
references.pmid: 1440718
references.citation: J Heart Valve Dis. 2001 Nov;10(6):703-11
references.pmid: 11767174
references.citation: Ann Thorac Surg. 2012 Aug;94(2):489-95; discussion 496
references.pmid: 22704800
references.citation: J Thorac Cardiovasc Surg. 1995 Dec;110(6):1745-55
references.pmid: 8523887
references.citation: Ann Neurol. 1990 Mar;27(3):238-46
references.pmid: 2327735
references.citation: Radiology. 2001 Jun;219(3):739-49
references.pmid: 11376263
references.citation: Eur J Cardiothorac Surg. 2002 May;21(5):948-50
references.pmid: 12062301
references.citation: Neurosurgery. 1993 Jan;32(1):45-9; discussion 49-50
references.pmid: 8421556
references.citation: Ann Thorac Surg. 2009 Jun;87(6):1728-33; discussion 1734
references.pmid: 19463586
references.citation: Eur Neurol. 1990;30(2):87-9
references.pmid: 2340840
references.citation: J Heart Valve Dis. 2010 May;19(3):321-5
references.pmid: 20583394
references.citation: Radiology. 2002 Feb;222(2):389-96
references.pmid: 11818604
references.citation: AJNR Am J Neuroradiol. 1994 Oct;15(9):1607-14
references.pmid: 7857409
references.citation: Stroke. 1987 Nov-Dec;18(6):1057-60
references.pmid: 3686577
references.citation: N Engl J Med. 2001 Nov 1;345(18):1318-30
references.pmid: 11794152
references.citation: Clin Infect Dis. 2008 Jul 1;47(1):23-30
references.pmid: 18491965