TY - CHAP
T1 - Neurologic complications of infective endocarditis
AU - Chakraborty, Tia
AU - Rabinstein, Alejandro
AU - Wijdicks, Eelco
N1 - Publisher Copyright:
© 2021 Elsevier B.V.
PY - 2021/1
Y1 - 2021/1
N2 - Infective endocarditis (IE) is an infection primarily affecting the endocardium of heart valves that can embolize systemically and to the brain. Neurologic manifestations include strokes, intracerebral hemorrhages, mycotic aneurysms, meningitis, cerebral abscesses, and infections of the spine. Neurologic involvement is associated with worse mortality, though it does not always portend a poor functional prognosis. Neuroimaging is indicated in patients who have neurologic symptoms, including cerebral vessel imaging in patients who have subarachnoid hemorrhage. In the case of acute ischemic stroke (IS), IV thrombolysis is contraindicated but endovascular thrombectomy may be a consideration. Neurologic findings understandably raise concern about valve surgery when indicated due to the risk of hemorrhage with perioperative anticoagulation. However, most neurologic complications do not preclude valve surgery and valve surgery may in fact be indispensable in some cases to prevent further neurologic problems. Management decisions in patients with IE and neurologic complications should therefore be multidisciplinary with a major contribution from the neurologist.
AB - Infective endocarditis (IE) is an infection primarily affecting the endocardium of heart valves that can embolize systemically and to the brain. Neurologic manifestations include strokes, intracerebral hemorrhages, mycotic aneurysms, meningitis, cerebral abscesses, and infections of the spine. Neurologic involvement is associated with worse mortality, though it does not always portend a poor functional prognosis. Neuroimaging is indicated in patients who have neurologic symptoms, including cerebral vessel imaging in patients who have subarachnoid hemorrhage. In the case of acute ischemic stroke (IS), IV thrombolysis is contraindicated but endovascular thrombectomy may be a consideration. Neurologic findings understandably raise concern about valve surgery when indicated due to the risk of hemorrhage with perioperative anticoagulation. However, most neurologic complications do not preclude valve surgery and valve surgery may in fact be indispensable in some cases to prevent further neurologic problems. Management decisions in patients with IE and neurologic complications should therefore be multidisciplinary with a major contribution from the neurologist.
KW - Infective endocarditis
KW - Intracerebral hemorrhage
KW - Mycotic aneurysm
KW - Stroke
KW - Valve surgery
UR - http://www.scopus.com/inward/record.url?scp=85101415108&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85101415108&partnerID=8YFLogxK
U2 - 10.1016/B978-0-12-819814-8.00008-1
DO - 10.1016/B978-0-12-819814-8.00008-1
M3 - Chapter
C2 - 33632430
AN - SCOPUS:85101415108
T3 - Handbook of Clinical Neurology
SP - 125
EP - 134
BT - Handbook of Clinical Neurology
PB - Elsevier B.V.
ER -