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Neuropathological complications of infective endocarditis : study of autopsy material
F M Patel1, A Das, A K Banerjee
1Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160012, India.
Abstract:
78 autopsy proven cases of infective endocarditis (IE) seen during 1983 to 1995 were retrospectively reviewed. The brain was available for examination in 44 cases. In the remaining cases, brain was not examined because examination of it was not requested due to lack of neurological findings. Brain lesions were observed in 35 out of 44 cases of IE. Assuming remaining 34 cases to be without brain lesions, the brain involvement in IE would be 44.87% (35 out of 78 cases). Mean age of all cases of IE and those with brain lesions was similar i.e. 26.5+/-16.6 years and 26.6+/-13.06 years respectively. Largest number of cases with neuropathological lesions were associated with normal valve IE (48.57%). Mitral valve was most commonly involved in cases with CNS complications (57.14%) (p<0.05). The various types of brain lesions were infarction (68.57%), haemorrhage (57.14%), cerebral micro-abscess (31.42%) and focal meningitis (14.28%). More than one type of lesion was observed in 19 cases, indicating complicated nature of brain lesions in fatal cases of IE. Left sided middle cerebral artery (MCA) territory was the commonest site of infarction and haemorrhage. Staphylococcus aureus appeared to be the most common organism in fatal cases of IE. Normal valve IE with or without CNS complications constitutes a significant group in India and is different from the west as far as the predisposing conditions are concerned.
Insights
Infective endocarditis (IE) frequently causes brain lesions, including infarction and hemorrhage, particularly in normal valve IE cases. Staphylococcus aureus was the most common pathogen identified in fatal IE with brain complications.
Area of Science:
- Neurology
- Cardiology
- Pathology
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves.
- Neurological complications are common in IE but vary in presentation and frequency.
- Understanding brain involvement patterns is crucial for patient outcomes.
Purpose of the Study:
- To retrospectively review autopsy-proven cases of infective endocarditis (IE).
- To determine the frequency and types of brain lesions in IE patients.
- To identify associations between valve status, causative organisms, and neurological complications.
Main Methods:
- Retrospective review of 78 autopsy-proven infective endocarditis cases (1983-1995).
- Detailed neuropathological examination of 44 brains; remaining cases excluded due to lack of neurological findings.
- Analysis of lesion types, locations, valve involvement, and associated microorganisms.
Main Results:
- Brain lesions were observed in 44.87% of all IE cases (35/78).
- Infarction (68.57%) and hemorrhage (57.14%) were the most common brain lesions.
- Normal valve IE (48.57%) and mitral valve involvement (57.14%) were significantly associated with central nervous system (CNS) complications.
- Staphylococcus aureus was the predominant organism in fatal IE cases with brain lesions.
Conclusions:
- Brain involvement is a significant complication of infective endocarditis, with infarction and hemorrhage being prevalent.
- Normal valve IE and mitral valve involvement are key factors in IE-related CNS complications.
- Findings suggest unique predisposing factors for IE with CNS complications in India compared to Western populations.