title: Cerebral imaging in infectious endocarditis: A clinical study.
abstract: BACKGROUND
  Because neurological failure is the most frequent extra-cardiac complication in Infectious Endocarditis (IE), a brain computerised tomography (CT) scan is usually performed. The benefits of magnetic resonance imaging (MRI) have not been clearly established. This study aims to clarify the prevalence and type of cerebral lesions in IE detected using MRI and to compare them with those detected using CT scans.
  
  
  METHODS
  In the Grenoble University Hospital, patients diagnosed with definite or possible endocarditis according to Duke's criteria were screened from 2010-2012. Brain CT and MRI were performed as soon as possible after diagnosis.
  
  
  RESULTS
  Of the 62 patients with IE who underwent at least one cerebral imaging within 3 weeks of diagnosis, Streptococcus (29) and Staphylococcus (14) were the main micro-organisms present. Twenty-eight (45%) patients underwent cardiac surgery. Eight (13%) died before discharge. Twenty (32%) had neurological symptoms. A brain CT-scan was performed on 53 (85%) patients and a MRI was performed on 43 (69%) patients. CT was pathological in 26 (49%) patients, whereas 32 (74%) MRI demonstrated abnormalities. The MRI lesions were classified as follows: ischaemia (48%), microbleeds (34%), haemorrhages (16%), abscesses (9%) and microbial aneurysms (4%). Of the 37 patients who underwent both MRI and CT examinations, ischaemia (48% vs 35%) and microbleeds (34%) demonstrated the difference between the two imaging methods.
  
  
  CONCLUSIONS
  Through the early diagnosis of cerebral damage, even in asymptomatic cases, MRI may have a role in the IE management, influence any surgical decision and assist in prognosis assessment.
authors.affiliation: a Anesthesiology and Intensive Care Department ;
authors.forename: Julia
authors.initials: J
authors.lastname: Champey
authors.affiliation: b Infectious Diseases Department ;
authors.forename: Patricia
authors.initials: P
authors.lastname: Pavese
authors.affiliation: c Cardiology Department ;
authors.forename: Hélène
authors.initials: H
authors.lastname: Bouvaist
authors.affiliation: d Public Health Department ;
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Vittoz
authors.affiliation: e Neuroradiology Department , CHU Grenoble , France ;
authors.forename: Florence
authors.initials: F
authors.lastname: Tahon
authors.affiliation: f Neuroradiology Department , CHU Montpellier , France ;
authors.forename: Omer F
authors.initials: OF
authors.lastname: Eker
authors.affiliation: b Infectious Diseases Department ;
authors.forename: Sandrine
authors.initials: S
authors.lastname: Goutier
authors.affiliation: g Bacteriology Department , CHU Grenoble , France.
authors.forename: Christine
authors.initials: C
authors.lastname: Recule
authors.affiliation: d Public Health Department ;
authors.forename: Patrice
authors.initials: P
authors.lastname: Francois
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000382:microbiology / Q000473:pathology*; D001927:Brain Diseases / Q000175:diagnosis* / Q000382:microbiology; D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000382:microbiology; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000473:pathology*; D005260:Female; D005602:France; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging / Q000379:methods*; D011379:Prognosis; D013203:Staphylococcal Infections / Q000150:complications / Q000473:pathology; D013210:Staphylococcus / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000150:complications / Q000473:pathology; D013291:Streptococcus / Q000302:isolation & purification; D014057:Tomography, X-Ray Computed
keywords: Infectious endocarditis; brain ischaemia; cardiac surgical procedures; cerebral microbleeds; magnetic resonance imaging