[Neurological manifestations as presentation of infectious endocarditis]

Neurologic complications of infective endocarditis (IE) are frequent. In many cases, they are the initial feature and considerably impair the prognosis of the disease. The most common neurologic manifestation is embolic stroke, but other many neurologic events have been described, ranged from cerebral hemorrhage due to rupture of mycotic aneurysm to the exceptional aseptic meningitis with acellular cerebrospinal fluid. We describe 3 cases that represent this wide spectrum of presentation. Ischemic stroke in the first patient and cerebral hemorrhage in the second were respectively documented several days before the diagnosis of IE. In the third case, acellular meningitis was the unusual clinical debut of aortic IE. Cerebral infarct or hemorrhage are exceptionally caused by an underlying IE, so a high level of suspicious is needed to recognize these complications. The best management to improve the prognosis has to be based on a rapid diagnosis and onset of antibiotic treatment, considering valve replacement in the adequate timing.