Cerebrovascular complications of infective endocarditis

We reviewed the cerebrovascular complications of 158 episodes of infective endocarditis occurring in 155 patients. Cerebrovascular complications occurred in 21 patients (14%). The incidences of cerebral embolism, intracerebral hemorrhage, and subarachnoid hemorrhage were 10%, 3%, and 1%, respectively. Death occurred in 33% of patients with cerebrovascular complications and 4% without. Patients whose condition was complicated by intracerebral hemorrhage had an even greater rate of mortality (80%). Sixty-two percent of cerebrovascular complications occurred within 2 days of antibiotic therapy; 29% occurred 2 weeks later. Two of three patients receiving open-heart surgery within 2 days of cerebrovascular complications died. Seventeen of 133 patients with native valve endocarditis and 4 of 22 patients with prosthetic valve endocarditis had cerebrovascular complications. Echocardiographic evidence of vegetation was seen in 120 patients, and cerebrovascular complications were noted in 16 patients. Twelve of 62 patients with mitral valve involvement detected by echocardiography and 4 of 40 patients with aortic valve involvement had cerebrovascular complications. According to the findings of surgery or pathology, 4 of 24 patients with mitral valve involvement and 4 of 36 patients with aortic valve involvement had cerebrovascular complications. We conclude that vegetation detected by echocardiography does not increase the risk of cerebrovascular complicatons; there is no difference in the incidence of cerebrovascular complications between the mitral and aortic valve groups, either by the involvement of vegetation detected by echocardiography or the surgical or pathologic findings; there is no difference in the incidence of cerebrovascular complications when comparing the native and prosthetic valve groups or the streptococcus viridans and Staphylococcus aureus groups; cerebrovascular complications, especially intracerebral hemorrhage, increase the risk of mortality in patients with infective endocarditis; although most cerebrovascular complications occurred within 2 days of antibiotic therapy, late onset of cerebrovascular complications are not uncommon; and it is better to avoid early open heart surgery in patients whose condition is complicated by intracerebral hemorrhage or hemorrhagic infarction.