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Imaging of the neurological complications of infective endocarditis
1Department of Radiology, Dankook University College of Medicine, Cheonan, Chungnam, Korea. sjkimjb@soback.kornet.nm.kr
Abstract:
We describe the findings on CT or MRI in five patients with neurological symptoms and underlying infective endocarditis (IE). We noted the size, number, and distribution of lesions, the presence or absence of haemorrhage, and contrast enhancement patterns. The number of lesions ranged from 4 to more than 10 in each patient. Their size varied from punctate to 6 cm; they were distributed throughout the brain. The lesions could be categorized into four patterns based on imaging features. A cortical infarct pattern was seen in all patients. Patchy lesions, which did not enhance, were found in the white matter or basal ganglia in three. Isolated, tiny, nodular or ring-enhancing white matter lesions were seen in three patients, and parenchymal haemorrhages in four. In addition to the occurrence of multiple lesions with various patterns in the same patient, isolated, tiny, enhancing lesions in the white matter seemed to be valuable features which could help to differentiate the neurological complications of IE from other thromboembolic infarcts.
Insights
Neurological complications of infective endocarditis (IE) present with varied brain lesions on CT/MRI. Tiny, enhancing white matter lesions may help distinguish IE from other causes of stroke.
Area of Science:
- Neurology
- Radiology
- Infectious Diseases
Background:
- Infective endocarditis (IE) can lead to serious neurological complications.
- Distinguishing IE-related brain lesions from other thromboembolic infarcts is clinically important.
Purpose of the Study:
- To characterize the CT and MRI findings in patients with neurological symptoms and infective endocarditis.
- To identify imaging features that differentiate neurological complications of IE.
Main Methods:
- Retrospective review of CT or MRI scans in five patients with infective endocarditis and neurological symptoms.
- Analysis of lesion characteristics including size, number, distribution, presence of hemorrhage, and contrast enhancement patterns.
Main Results:
- All patients showed a cortical infarct pattern.
- Lesions varied from punctate to 6 cm, with 4 to over 10 lesions per patient.
- Four distinct imaging patterns were observed, including non-enhancing patchy lesions, tiny enhancing white matter lesions, and parenchymal hemorrhages.
- Isolated, tiny, enhancing white matter lesions were noted in three patients.
Conclusions:
- Neurological complications of IE exhibit diverse imaging patterns on CT/MRI.
- The presence of multiple lesion types and particularly isolated, tiny, enhancing white matter lesions are valuable indicators for differentiating IE from other thromboembolic events.