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Neurologic Complications of Infective Endocarditis: Recent Findings

  • Central Nervous System Infections (K Bloch, Section Editor)
  • Published:
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Abstract

Purpose of Review

The purpose of this paper is to provide recent insights in management of neurologic complications of left-sided infective endocarditis (IE).

Recent Findings

Cerebral lesions observed in IE patients are thought to involve synergistic pathophysiological mechanisms including thromboembolism, sepsis, meningitis, and small-vessel cerebral vasculitis. Brain MRI represents a major tool for the detection of asymptomatic events occurring in the majority of patients. The latter can impact therapeutic decisions and prognosis, especially when cardiac surgery is indicated. In patients presenting with neurologic complications, surgery could be safely performed earlier than previously thought.

Summary

Symptomatic cerebral ischemic or hemorrhagic events occur in 20–55% of IE patients, whereas asymptomatic events are detected in 60–80% of patients undergoing systematic brain MRI. Management of such patients requires an experienced multidisciplinary team. Recent studies suggest that early cardiac surgery, when indicated, can be performed safely in patients with cerebral ischemic events. Other important issues include the appropriate use of anti-infective and anti-thrombotic agents, and endovascular treatment for mycotic aneurysms. Altered mental status at IE onset, which is associated with brain injury, is a major determinant of short-term outcome.

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Authors and Affiliations

  1. Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique – Hôpitaux de Paris, 46 rue Henri Huchard, 75018, Paris, France

    Marie Cantier, Michel Wolff, J. F. Timsit & Romain Sonneville

  2. INSERM U1148, Université Paris Diderot, Sorbonne Paris Cité, Paris, France

    Marie Cantier, Mikael Mazighi, J. P. Desilles & Romain Sonneville

  3. Department of Neurology, Lariboisière University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France

    Mikael Mazighi

  4. Imaging Department, Clinique Alleray Labrouste, Paris, France

    Isabelle Klein

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  1. Marie Cantier
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Cantier, M., Mazighi, M., Klein, I. et al. Neurologic Complications of Infective Endocarditis: Recent Findings. Curr Infect Dis Rep 19, 41 (2017). https://doi.org/10.1007/s11908-017-0593-6

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