Neurologic complications of infective endocarditis

Area of Science:

• Cardiology
• Neurology
• Infectious Diseases

Background:

• Infective endocarditis (IE) is a heart valve infection with potential systemic and cerebral embolization.
• Neurologic manifestations of IE include stroke, hemorrhage, and abscesses, associated with higher mortality.
• Neurologic involvement complicates management but does not always indicate a poor functional outcome.

Purpose of the Study:

• To review the neurologic manifestations of infective endocarditis.
• To discuss neuroimaging indications and treatment considerations for neurologic complications of IE.
• To clarify the role of valve surgery in IE patients with neurologic involvement.

Main Methods:

• Literature review of neurologic complications in infective endocarditis.
• Analysis of neuroimaging modalities and their utility.
• Discussion of therapeutic strategies, including anticoagulation and surgical intervention.

Main Results:

• Neuroimaging is crucial for patients with neurologic symptoms, including cerebral vessel imaging for subarachnoid hemorrhage.
• While IV thrombolysis is contraindicated for acute ischemic stroke in IE, endovascular thrombectomy may be considered.
• Most neurologic complications do not contraindicate valve surgery, which can be essential for preventing further issues.

Conclusions:

• Multidisciplinary management involving neurologists is vital for IE patients with neurologic complications.
• Valve surgery is often indispensable in IE cases with neurologic involvement, despite hemorrhage risks from anticoagulation.
• Careful consideration of neurologic status is necessary when deciding on valve surgery in infective endocarditis.