title: When the heart rules the head: ischaemic stroke and intracerebral haemorrhage complicating infective endocarditis.
abstract: Sir William Osler meticulously described the clinical manifestations of infective endocarditis in 1885, concluding that: 'few diseases present greater difficulties in the way of diagnosis … which in many cases are practically insurmountable'. Even with modern investigation techniques, diagnosing infective endocarditis can be hugely challenging, yet is critically important in patients presenting with stroke (both cerebral infarction and intracranial haemorrhage), its commonest neurological complication. In ischaemic stroke, intravenous thrombolysis carries an unacceptably high risk of intracranial haemorrhage, while in intracerebral haemorrhage, mycotic aneurysms require urgent treatment to avoid rebleeding, and in all cases, prompt treatment with antibiotics and valve surgery may be life-saving. Here, we describe typical presentations of ischaemic stroke and intracerebral haemorrhage caused by infective endocarditis. We review the diagnostic challenges, the importance of rapid diagnosis, treatment options and controversies.
authors.affiliation: Department of Neurology, National Hospital for Neurology & Neurosurgery, Queen Square, London, UK.
authors.forename: Estabrak
authors.initials: E
authors.lastname: Jiad
authors.affiliation: Department of Neurology, National Hospital for Neurology & Neurosurgery, Queen Square, London, UK.|Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK.
authors.forename: Sumanjit K
authors.initials: SK
authors.lastname: Gill
authors.affiliation: Department of Neurology, National Hospital for Neurology & Neurosurgery, Queen Square, London, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Krutikov
authors.affiliation: Department of Neurology, National Hospital for Neurology & Neurosurgery, Queen Square, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Turner
authors.affiliation: Department of Neurology, National Hospital for Neurology & Neurosurgery, Queen Square, London, UK.
authors.forename: Michael H
authors.initials: MH
authors.lastname: Parkinson
authors.affiliation: Department of Microbiology, University College Hospital, London, UK.
authors.forename: Carmel
authors.initials: C
authors.lastname: Curtis
authors.affiliation: Department of Neurology, National Hospital for Neurology & Neurosurgery, Queen Square, London, UK d.werring@ucl.ac.uk.|Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Werring
mesh_terms: D000328:Adult; D002545:Brain Ischemia / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D002543:Cerebral Hemorrhage / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D004696:Endocarditis / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D020521:Stroke / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy
keywords: Endocarditis; Infectious Diseases; Intracerebral haemorrhage; Stroke