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[Neurological complications of infectious endocarditis]
Insights
Neurological complications are common in infectious endocarditis (IE), often appearing early. These complications significantly increase mortality risk in IE patients.
Area of Science:
- Neurology
- Infectious Diseases
- Cardiology
Context:
- Infectious endocarditis (IE) is a serious infection affecting heart valves.
- Neurological complications represent a significant challenge in IE management.
- This study analyzes neurological complications in a large cohort of IE patients over two decades.
Purpose:
- To investigate the incidence, types, and timing of neurological complications in patients with infectious endocarditis.
- To identify clinical features associated with neurological involvement in IE.
- To assess the impact of neurological complications on mortality and survival rates in IE patients.
Summary:
- A retrospective analysis of 204 infectious endocarditis patients (1980-2000) revealed neurological complications in 21.2%.
- Ischemic stroke was the most frequent (72.1%), often occurring before or early in treatment, particularly in the left carotid territory.
- Patients presented acutely with paresis, fever, anemia, and leukocytosis. Mortality was substantially higher (58.1%) in those with neurological complications compared to those without (14.9%).
Impact:
- Highlights the high prevalence and severe consequences of neurological complications in infectious endocarditis.
- Underscores the need for early recognition and management of neurological issues in IE patients.
- Provides crucial data on long-term survival rates, emphasizing the persistent risk even after hospital discharge.
Abstract:
Of 204 patients with infectious endocarditis (IE) treated in the hospital in 1980-2000, 43(21.2%) developed neurological complications. These were: ischemic stroke (72.1%), hemorrhagic stroke (9.3%), both (7%), abscess and subarachnoidal hemorrhage (2.3% for each), meningitis (7%), toxic encephalopathy (11.6%). Neurological complications of IE arose prior to treatment and within the first week of antibacterial therapy in 63% cases, more frequently in the left carotid territory. Neurological complications in IE debute manifested acutely, pareses were more frequent than paralyses, with elevated temperature, low hemoglobin and red cell levels, leukocytosis. MRT detected 8 +/- 4.6 foci in the brain, CT--2 +/- 1.1, on the average. Lethality of IE patients with neurological complications reached 58.1% and was significantly higher than in those without such complications (14.9%, p < 0.001). Overall acturial survival 1 year after the discharge from the hospital was 94.4%, 5-year survival--61.1%, 10-year survival--11%.