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Neurological presentations of native valve endocarditis
W R Gransden1, S J Eykyn, R M Leach
1Department of Microbiology, United Medical School, Guy's Hospital, St Thomas's Campus, London.
The Quarterly Journal of Medicine
|December 1, 1989
Summary
Neurological symptoms like meningitis and stroke are common in infective endocarditis, particularly with Staphylococcus infections. These neurological presentations are associated with a higher mortality rate in patients with this serious heart valve infection.
Area of Science:
- Infectious Diseases
- Neurology
- Cardiology
Background:
- Infective endocarditis (IE) is a serious infection affecting heart valves.
- Neurological complications are known to occur in IE but their frequency varies by causative organism.
Purpose of the Study:
- To investigate the incidence and characteristics of neurological presentations in community-acquired native valve infective endocarditis.
- To determine the association between specific bacterial pathogens and neurological involvement.
- To assess the impact of neurological presentation on mortality in IE.
Main Methods:
- Prospective study of 178 episodes of community-acquired native valve infective endocarditis.
- Data collected between 1969 and 1987 at St Thomas' Hospital.
- Analysis of patient demographics, causative organisms, clinical presentations (including neurological disorders), and outcomes.
Main Results:
- 33% of patients (59/178) presented with neurological disorders (meningitis, confusion, thromboembolism, headache).
- Staphylococcal endocarditis had a higher rate of neurological presentation (54%) compared to 'viridans' streptococcal and enterococcal endocarditis (19%).
- One-third of staphylococcal IE patients showed meningitis symptoms, with 40% having no cardiac murmur.
- Patients with neurological presentations had a higher mortality rate than those without.
Conclusions:
- Neurological disorders are a significant and frequent presentation of community-acquired native valve infective endocarditis.
- Staphylococcus aureus is strongly associated with neurological complications in IE.
- Early recognition of neurological signs in IE is crucial as it indicates a poorer prognosis.