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Brain abscesses in infective endocarditis: contemporary profile and neuroradiological findings

Monique Boukobza1, Emila Ilic-Habensus2, Bruno Mourvillier3

  • 1Department of Radiology, Bichat Hospital, Assistance Publique-Hôpitaux de Paris, 46 Rue Henri Huchard, 75018, Paris, France. m.boukobza@orange.fr.

Infection
|February 28, 2023
PubMed
Abstract

Insights

Brain abscesses (BAs) in infective endocarditis (IE) patients are linked to higher rates of predisposing conditions, rare pathogens, and meningitis. Brain MRI is crucial for detecting BAs, even in asymptomatic cases.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Cardiology

Background:

  • Brain abscesses (BAs) represent a severe complication of infective endocarditis (IE).
  • Understanding the characteristics and outcomes of IE patients with BAs is crucial for clinical management.
  • This study compares IE patients with and without BAs to identify risk factors and assess BA characteristics.

Purpose of the Study:

  • To compare bacteriological, clinical, and background data of IE patients with and without brain abscesses.
  • To analyze associated lesions and outcomes in IE patients with and without BAs.
  • To assess the magnetic resonance imaging (MRI) characteristics of brain abscesses in IE patients.

Main Methods:

  • Retrospective study including 351 consecutive patients with definite IE between 2005 and 2020.
  • All patients underwent at least one brain MRI.
  • Comparison of patients with and without BAs based on various clinical and microbiological parameters.

Main Results:

  • 5.7% of IE patients (20/351) had BAs, predominantly in younger men with higher rates of predisposing factors (previous IE, IV drug use, HIV, alcohol abuse, liver disease, hemodialysis, type 2 diabetes).
  • BA patients showed increased incidence of bacterial meningitis, rare IE agents, and extra-cerebral abscesses; valve vegetations were larger.
  • MRI revealed multiple (80%), bilateral (55%), small (≤10 mm, 72%) BAs. Clinical presentation suggested BA in only 35% of cases. Favorable outcome was observed in 85%.

Conclusions:

  • IE patients with BAs have significantly higher rates of predisposing conditions, rare IE agents, meningitis, and metastatic abscesses.
  • Brain abscesses can occur in asymptomatic IE patients, highlighting the importance of brain MRI.
  • The impact of brain MRI on the management of BA-IE patients requires further investigation.
Keywords:
Brain abscessInfective endocarditisIntracranial infectious aneurysmIntravenous drug useMeningitis

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