Subarachnoid haemorrhage associated with infectious endocarditis: Case report and literature review

Cases of subarachnoid haemorrhage (SAH) as a presenting feature or soon after initiation of antibiotics in infectious endocarditis (IE) have been reported. However, most had documented mycotic aneurysms as the source of haemorrhage. Reports of IE associated with SAH of unclear source are rare. A case of SAH associated with IE is reported. We also reviewed our data set on neurological complications of IE at Mayo Clinic Rochester from 1980 to 1996 for additional cases. In addition to the index case, we identified seven cases of SAH amongst 489 patients (1%) with IE for a total of eight cases. In six patients, initial cerebral angiography, magnetic resonance angiography or autopsy did not show aneurysm or other aetiology for the SAH. A mycotic aneurysm was noted in one case and the other patient had an unruptured mycotic aneurysm of the tip of basilar artery. SAH was located in the basal cistern in two patients, sylvian fissure in three, and hemispheric sulci in three. SAH is an uncommon complication of IE, and in the setting of IE a specific cause, such as mycotic aneurysm, may not be identified.