title: Clinical characteristics and thrombolytic outcomes of infective endocarditis-associated stroke.
abstract: OBJECTIVE
  Our aim was to describe the clinical features of infective endocarditis (IE) in the acute stroke setting and outcomes following thrombolytic therapy.
  
  
  METHODS
  This is a single-center, retrospective, descriptive case series of IE-related stroke (IES). Infective endocarditis diagnosis was based on the modified Duke criteria.
  
  
  RESULTS
  From 2001 to 2007, 18 patients with acute stroke had definite or possible IE. Presenting stroke subtypes were: 11 ischemic stroke; 2 intracerebral hemorrhage; and 5 with a combination of ischemia and subarachnoid hemorrhage. On presentation, 6 had objective fever and 5 had subjective fever, 8 had heart murmur, and 3 had classic IE stigmata. The most common laboratory abnormalities were leukocytosis (n = 11) and anemia (n = 10). Sixteen patients had valvular vegetations on echocardiogram; 6 of 8 patients had vegetations visualized on transesophageal echocardiogram that were not detected by transthoracic echocardiogram. Two of the 3 patients with valve replacements had vegetations only on their native valves. Of 11 patients with pure ischemic stroke, 4 received thrombolytics and had hemorrhagic conversion. Overall mortality of IES was 56% (10 of 18). Mortality in pure ischemic IES patients was 29% (2 of 7, median National Institute of Health Stroke Scale [NIHSS] 13) in those not receiving thrombolytics and 75% (3 of 4, median NIHSS 14) in those receiving thrombolytics.
  
  
  CONCLUSIONS
  Though diagnosis of IE in the acute stroke setting is difficult, features of the history, examination, and laboratory data may raise concern for IE. In this case series, thrombolytics in patients with IE-associated stroke were associated with very poor outcomes.
authors: Department of Neurology, University of Utah, Salt Lake City, UT, USA.
authors: Kevin A
authors: KA
authors: Walker
authors: Jacinda B
authors: JB
authors: Sampson
authors: Elaine J
authors: EJ
authors: Skalabrin
authors: Jennifer J
authors: JJ
authors: Majersik
keywords: central nervous system bacterial infections (infective endocarditis); intracranial hemorrhages; outcomes (techniques); stroke (cerebrovascular disorders); thrombolysis
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