title: Brain MRI findings in neurologically asymptomatic patients with infective endocarditis.
abstract: OBJECTIVE
  Neurologic complications in infective endocarditis are frequent and affect patient prognosis negatively. Additionally, detection of asymptomatic lesions by MR imaging could help early management of this condition. The objective of our study was to describe MR imaging characteristics of cerebral lesions in a neurologically asymptomatic population with infective endocarditis.
  
  
  METHODS
  One hundred nine patients at the acute phase of a definite or possible infective endocarditis according to the Duke modified criteria and without neurologic manifestations according to the NIHSS were prospectively included. Each patient underwent cerebral MR imaging and MRA within 7 days of admission.
  
  
  RESULTS
  MR imaging showed abnormalities in 78 patients (71.5%). Acute ischemic lesions (40 patients, 37%) and cerebral microbleeds (62 patients, 57%) were the most frequent lesions. Eight patients had an acute SAH, 3 patients had brain microabscesses, 3 had a small cortical hemorrhage, and 3 had a mycotic aneurysm. Acute ischemic lesions mostly appeared as multiple small infarcts disseminated in watershed territories (25/40, 62.5%) and as lesions of different ages (21/40, 52.5%). Cerebral microbleeds were preferentially distributed in cortical areas (362/539 cerebral microbleeds, 67%). No significant correlation was found among lesions, in particular between acute ischemia and cerebral microbleeds.
  
  
  CONCLUSIONS
  Occult cerebral lesions, in particular cerebral microbleeds and acute ischemic lesions, are frequent in infective endocarditis. The MR imaging pattern of acute small infarcts of different ages predominating in watershed territories and cortical cerebral microbleeds may represent a surrogate imaging marker of infective endocarditis.
authors: Service de Radiologie, EA 3964, Hôpital Universitaire Bichat, Paris, France. agathehess@gmail.com
authors: A
authors: A
authors: Hess
authors: I
authors: I
authors: Klein
authors: B
authors: B
authors: Iung
authors: P
authors: P
authors: Lavallée
authors: E
authors: E
authors: Ilic-Habensus
authors: Q
authors: Q
authors: Dornic
authors: F
authors: F
authors: Arnoult
authors: L
authors: L
authors: Mimoun
authors: M
authors: M
authors: Wolff
authors: X
authors: X
authors: Duval
authors: J-P
authors: JP
authors: Laissy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology*; D001927:Brain Diseases / Q000453:epidemiology* / Q000473:pathology*; D015984:Causality; D015897:Comorbidity; D004696:Endocarditis / Q000453:epidemiology* / Q000473:pathology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity
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