Bacterial Endocarditis and Cerebrovascular Disease.
Cerebrovascular complications of endocarditis occur in 25-70% of patients with infective endocarditis. The cornerstone of treatment is early initiation of antibiotic treatment, which significantly reduces the risk of embolization after 1 week of treatment. In general, thrombolysis and anticoagulation of these patients should be avoided, while antiplatelet therapy may be considered in those with other indications. Endovascular treatment of acute septic emboli is uncertain, but a few case reports have demonstrated benefit. Other complications of infective endocarditis include intracerebral hemorrhage, which may be predicted by the presence of two or more cerebral microbleeds on gradient echo sequences. Intracranial mycotic aneurysms can often be managed with serial imaging and coiled if there is evidence of failure to reduce in size, or enlargement.
Department of Neurology, Rhode Island Hospital/Alpert Medical School of Brown University, 593 Eddy Street, APC 5, Providence, RI, 02903, USA. Brian_Silver@brown.edu.
Brian
B
Silver
University of Texas School of Medicine at San Antonio, 8300 Floyd Curl Drive, MC 7883, San Antonio, 78229, TX, USA.
Réza
R
Behrouz
U.F. Health, Department of Neurology, University of Florida, Jacksonville, 580 W. 8th St., Jacksonville, FL, 32209, USA.
Scott
S
Silliman
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging / Q000209:etiology*; D004697:Endocarditis, Bacterial / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000209:etiology*
D000900:Anti-Bacterial Agents
Endocarditis; Review; Stroke