title: Infective Endocarditis Presenting with Intracranial Bleeding.
abstract: BACKGROUND
  Infective endocarditis (IE) can be complicated by intracranial bleeding (ICB) caused by different pathologic mechanisms. The occurrence of ICB in patients with IE significantly influences therapeutic decisions and has a negative impact on outcome.
  
  
  METHODS
  We describe the clinical courses of 3 patients with aortic prosthetic valve IE presenting with ICB. Patients 1 and 2 experienced subarachnoid hemorrhage (SAH) and intracerebral hemorrhage (ICH), respectively, caused by rupture of an intracranial infectious aneurysm (IIA). Both underwent endovascular treatment of IIA with good outcome. In patient 3, ICB was the hemorrhagic conversion of an acute ischemic lesion from septic brain embolization. In the subacute phase of the disease, aortic valve replacement was performed, with excellent outcome. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ICB is a relevant complication and sometimes the first clinical feature of IE. Imaging of brain vessels should be performed to investigate the pathologic mechanism underlying ICB. The prevalence of IIA is probably underestimated and may influence the therapeutic strategy. Cerebrovascular imaging may therefore also be considered in asymptomatic subjects with left-sided IE. Withdrawal of anticoagulant treatment and delay of cardiac surgery are recommended in all cases of IE complicated by ICB. Because of the impact of ICB on IE management and outcome, a high level of clinical suspicion and prompt recognition and treatment of this complication are necessary.
authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Morotti
authors.affiliation: Dipartimento di Scienze Neurologiche e della Visione, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Gamba
authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Costa
authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Loris
authors.initials: L
authors.lastname: Poli
authors.affiliation: Dipartimento di Scienze Neurologiche e della Visione, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gilberti
authors.affiliation: Dipartimento di Scienze Neurologiche e della Visione, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: Ilenia
authors.initials: I
authors.lastname: Delrio
authors.affiliation: Dipartimento di Diagnostica per Immagini, Neuroradiologia, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Dikran
authors.initials: D
authors.lastname: Mardighian
authors.affiliation: Dipartimento di Diagnostica per Immagini, Neuroradiologia, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gasparotti
authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Padovani
authors.affiliation: Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Pezzini
mesh_terms: D000328:Adult; D015901:Angiography, Digital Subtraction / Q000379:methods; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery*; D002097:C-Reactive Protein / Q000032:analysis; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000592:standards; D002543:Cerebral Hemorrhage / Q000150:complications / Q000209:etiology; D000072226:Computed Tomography Angiography / Q000379:methods; D004696:Endocarditis / Q000150:complications*; D005334:Fever / Q000209:etiology; D051270:Headache Disorders, Primary / Q000209:etiology; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D002532:Intracranial Aneurysm / Q000209:etiology; D020300:Intracranial Hemorrhages / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging / Q000209:etiology
chemical_list: D002097:C-Reactive Protein
keywords: infectious aneurysm; infective endocarditis; intracerebral hemorrhage; subarachnoid hemorrhage