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Updated: Jan 12, 2026
Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
Published on: October 15, 2021
Urgent Cardiac Surgery for Endocarditis and Intracranial Hemorrhage Causing Midline Cerebral Shift
Kenza Rahmouni1, Daniel Goubran1, David Messika-Zeitoun2
1Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Insights
Intracranial hemorrhage from infective endocarditis can be serious. Early cardiac surgery, despite guidelines, may be safe and effective in select cases, especially with heart failure or new emboli.
Area of Science:
- Cardiology
- Neurology
- Infectious Diseases
Background:
- Intracranial hemorrhage is a rare but severe complication of infective endocarditis.
- Current guidelines suggest a 4-week interval between intracranial hemorrhage and cardiac surgery.
- Exceptions exist for earlier intervention, including refractory heart failure and embolic events.
Abstract:
Intracranial hemorrhage is a rare and severe complication of infective endocarditis. Current treatment guidelines recommend 4 weeks between intracranial hemorrhage onset and cardiac surgery. However, some exceptions warrant earlier surgical interventions, namely, refractory congestive heart failure and ongoing embolic phenomena. We report a case of mitral valve infective endocarditis complicated by intracranial hemorrhage associated with midline cerebral shift, in which successful early surgical intervention was performed without neurologic complication. This case highlights the importance of careful surgical timing through thorough multidisciplinary discussions to provide optimal clinical outcomes as well as the need for disease registries to share patient care decisions.
