Clinical Study in Patients of Infectious Endocarditis with Neurological Complications

Hemorrhagic or ischemic stroke in patients with infectious endocarditis is still a devastating complication. During past 19 years, we had observed 20 patients with neurological complications following infectious endocarditis. Age of the patients ranged from 13 to 70 years, mean age of 35 years. Fourteen patients had intracranial hemorrhage and 6 had cerebral infarction. Bacterial aneurysm was found in 13 out of 20 patients with the stroke. Angiography demonstrated bacterial aneurysms in 9 patients with hemorrhagic stroke and in 3 with ischemic stroke. Two patients with bacterial aneurysm and large hematoma died of uncontrolled increased intracranial pressure prior to serial angiography. One patient with enlarged aneurysm demonstrated by angiography died of reruptured bacterial aneurysm in the clinical course. Follow-up angiography was performed in 12 patients with bacterial aneurysm. Autopsy was performed in 2 patients. Appropriate high-dose antibiotics administration was effective for the resolution of aneurysm in 7 days to 1 year. Two patients with bacterial aneurysm and large hematoma, and 2 patients with bacterial aneurysm after resolution of infectious endocarditis were treated surgically, resulting in good outcome. No patient demonstrated newly formed bacterial aneurysm in this series. Two patients demonstrated focal infective angitis and aneurysm angiographically, developed intracranial hemorrhage. One of the patients died of large intracranial hematoma and uncontrolled increased intracranial pressure. We recommend cerebral angiography in patients with stroke following infectious endocarditis to find out harbored bacterial aneurysm or focal infectious angitis resulting in intracranial hemorrhage, although the timing of the angiography depends on the state of the patients