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Acute convexity subarachnoid hemorrhage (cSAH) in infectious endocarditis (IE): imaging features and follow-up

Monique Boukobza1, Emila Ilic-Habensus2, Xavier Duval3,4

  • 1Department of Radiology, Bichat Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. m.boukobza@orange.fr.

Journal of Neurology
|June 5, 2020
PubMed

Insights

Convexity subarachnoid hemorrhage (cSAH) in infective endocarditis (IE) is often incidental but can indicate intracranial infectious aneurysms (IIAs). This finding does not predict poor prognosis in patients without IIAs.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Radiology

Background:

  • Infective endocarditis (IE) can lead to neurological complications.
  • Convexity subarachnoid hemorrhage (cSAH) is a rare finding in IE patients.

Purpose of the Study:

  • To determine the prevalence and characteristics of cSAH in IE.
  • To investigate the association of cSAH with IE features and other lesions.
  • To assess cSAH as a predictor of future hemorrhage and its role in cortical superficial siderosis (cSS).

Main Methods:

  • Retrospective analysis of MRI data from 240 IE patients.
  • Evaluation of cSAH location, associated lesions, and occurrence of new lesions and cSS at follow-up.
  • Comparison of patients with and without cSAH.

Main Results:

  • 21 cSAH-IE patients identified; 10 had intracranial infectious aneurysms (IIAs).
  • cSAH was incidental in 71% and associated with valvular vegetations and mitral valve involvement.
  • Associated lesions included cerebral microbleeds (CMBs) and diffusion-weighted imaging lesions (DWILs).

Conclusions:

  • cSAH in IE is often incidental but can signify IIA.
  • cSAH is not a marker of poor prognosis in IE patients without IIA.
  • cSS associated with cSAH may resolve over time.
Abstract

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