Intracranial bleeding (ICB) as a catastrophic complication of

Area of Science:

• Neurology
• Infectious Diseases
• Cardiology

Background:

• Infective endocarditis (IE) is a serious infection of the heart's inner lining.
• Streptococcus gordonii is a known cause of IE, typically treated with antibiotics.
• Intracranial bleeding (ICB) is a rare but severe complication of IE.

Observation:

• A young woman with IE caused by Streptococcus gordonii developed late-onset neurological symptoms.
• Despite two weeks of antibiotic treatment, she presented with seizures and a focal neurological sign.
• A non-contrast CT brain scan revealed a massive left frontoparietal intraparenchymal hemorrhage.

Findings:

• The massive ICB was strongly suspected to be a vascular complication of infective endocarditis.
• CT angiography did not show active bleeding or contrast extravasation.
• Surgical intervention via decompressive craniectomy with clot evacuation was performed urgently.

Implications:

• This case underscores the potential for severe neurological complications, including ICB, in infective endocarditis, even during treatment.
• Prompt recognition and surgical management are crucial for mitigating mass effect from ICB.
• Long-term sequelae, such as global aphasia, can occur despite successful treatment of the infection and bleeding.