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Intracranial Hemorrhage as a Marker for Mycotic Aneurysm in Patients With Infective Endocarditis

Thomas J Williams1, Matthew Starr1, Sami El-Dalati1

  • 1Department of Neurology (TJW, MS), University of Pittsburgh Medical Center, Pittsburgh, PA; Division of Infectious Diseases, Department of Internal Medicine, (SE-D) University of Kentucky Medical Center, Lexington, KY.

Neurology. Clinical Practice
|April 17, 2023
PubMed
Abstract

Insights

Infective endocarditis patients with intracranial hemorrhage are more likely to have mycotic aneurysms. Absence of intracranial hemorrhage on imaging may rule out mycotic aneurysms, potentially avoiding invasive DSA.

Area of Science:

  • Neurology
  • Cardiology
  • Infectious Diseases

Background:

  • Mycotic aneurysms are a serious complication of infective endocarditis (IE).
  • Digital subtraction angiography (DSA) is the gold standard for diagnosis but is invasive.
  • Predictive factors for mycotic aneurysms in IE patients need identification.

Purpose of the Study:

  • To identify predictive factors for mycotic aneurysms in patients with infective endocarditis (IE).

Main Methods:

  • Retrospective review of 36 patients with IE and patent foramen ovale (PFO) undergoing valve surgery evaluation.
  • Stratification by demographics, imaging, and outcomes.
  • Statistical analysis including chi-square, Fisher exact, and t-tests.

Main Results:

  • 5 out of 24 patients (13.9%) had mycotic aneurysms detected by DSA.
  • 4 of 5 patients with mycotic aneurysms presented with intracranial hemorrhage (ICH).
  • The negative predictive value of absent ICH on initial CNS imaging for mycotic aneurysms was 97.4%.

Conclusions:

  • Patients with IE, PFO, and ICH on CNS imaging are more likely to have mycotic aneurysms.
  • Routine DSA may not be necessary for IE patients without ICH on initial imaging.

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