[Neurologic complications of infectious endocarditis]

Ten patients with neurological complications (NC) among a retrospective series of 53 consecutive cases of infective endocarditis were studied: 6 males and 4 females, mean age 60 years. NC were present at admission in 6 cases: 2 generalized seizures, 4 strokes, associated with 2 meningeal syndromes. Four cases of NC occurred during hospitalization: 1 stroke with come, 1 transient ischaemic attack, 2 generalized seizures. Blood cultures were positive in 7 cases: 6 group D Streptococci, 1 Gram negative bacillus. Five digestive portal of entry were identified. Cerebrospinal fluid was purulent in 1 patient, aseptic in 1, haemorragic in 2, and normal in 1. Cranial computed tomography revealed: infarct in 4 cases, brain abscess in 1 case, absence of abnormality in 1 case. There was no angiographic documentation. Antimicrobial therapy was maintained 5 to 6 weeks. Two patients underwent cardiac surgery. Two patients died of subarachnoid haemorrage. Comparison of patients with NC, and the 43 without NC, revealed two different point: vegetations were more frequent in the NC (8 cases out of 10) than without NC (19 cases out of 43) (p = 0.04). Streptoccus was often more found in NC (6 cases out of 6) than without NC (6 cases out of 24) (p < 0.01). Compared with the previously reported studies, where Staphylococcus was usually described, our results showed a higher frequency of Streptococcus D bovis, an older age, a higher frequency of stroke and digestive portal of entry. Vegetations were more frequent with NC than without.