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Shen Y, Hu F, Wu L, Nie H. Concomitant rapidly growing aneurysm of intracavernous carotid artery and cavernous sinus thrombosis: Case report and review of the literature. Medicine (Baltimore) 2024; 103:e39022. [PMID: 39058832 PMCID: PMC11272256 DOI: 10.1097/md.0000000000039022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/01/2024] [Indexed: 07/28/2024] Open
Abstract
RATIONALE Intracavernous infectious aneurysm (ICIA), represents a rare entity that is always described in the form of case reports in the literature. The coexistence of ICIA and cavernous sinus thrombosis (CST) is extremely rare and poorly understood. PATIENT CONCERNS A 53-year-old female patient presented to our hospital with headache, nausea and fatigue for 3 weeks. She complained of blurry vision and drooping eyelids before admission. Neurological examination revealed bilateral decreased visual acuity, limitation of extraocular movements and decreased sensation of forehead. Brain magnetic resonance imaging (MRI) showed mixed signal intensities in both cavernous sinuses and expansion of right superior ophthalmic vein, suggesting the formation of CST. One month later, computed tomography angiography (CTA) confirmed a large aneurysm was attached to the left intracavernous carotid artery (ICCA). DIAGNOESE This patient was diagnosed with ICIA and CST. INTERVENTIONS She was administered with intravenous meropenem and vancomycin and subcutaneous injection of low molecular heparin for 4 weeks. OUTCOMES One month later, her extraocular movement had significantly improved, without ptosis and conjunctival congestion. At 1-year follow-up, her ophthalmoplegia fully recovered. Fortunately, such large aneurysm did not rupture in spite of slight broadening. LESSONS The coexistence of ICIA and CST is extremely rare. Contiguous infection from adjacent tissues is the foremost cause of ICIA. A repeated angiographic examination is recommended under enough anti-infective treatment due to the characteristics of rapid emergence and fast growth of infectious aneurysms.
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Affiliation(s)
- Yaoyao Shen
- Department of Neurology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
- Department of Neurology, Xiangya Hospital, Central South University, Jiangxi, National Regional Center for Neurological Diseases, Nanchang, Jiangxi Province, China
| | - Fan Hu
- Department of Neurology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
- Department of Neurology, Xiangya Hospital, Central South University, Jiangxi, National Regional Center for Neurological Diseases, Nanchang, Jiangxi Province, China
| | - Lingfeng Wu
- Department of Neurology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
- Department of Neurology, Xiangya Hospital, Central South University, Jiangxi, National Regional Center for Neurological Diseases, Nanchang, Jiangxi Province, China
| | - Hongbing Nie
- Department of Neurology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi Province, China
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Rodríguez-Montolio J, Meseguer-Gonzalez D, Almeida-Zurita M, Revilla-Martí P, Santos-Lasaosa S. Prevalence of neurological complications in infective endocarditis. Neurologia 2024; 39:443-448. [PMID: 37085083 DOI: 10.1016/j.nrleng.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/24/2021] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Neurological complications are the most frequent type of extracardiac complications of infective endocarditis (IE), and can be the initial manifestation. The objectives of this study were to determine the prevalence of neurological complications in patients with IE and to evaluate whether initial presentation with neurological symptoms causes a diagnostic delay. MATERIAL AND METHODS We conducted a retrospective observational study of patients with IE admitted to a tertiary hospital between 2003 and 2020. RESULTS The study included 222 patients with IE (67% men; mean [SD] age, 66.4 [14.2] years). Neurological complications occurred in 21.2% of patients, with ischaemic stroke (74.5%) and intracerebral haemorrhage (23.4%) being the most frequent. No differences in diagnostic delay were found between the group of patients in whom the disease manifested with neurological complications and the rest of the patients (4.4 vs 4.5; P = .76). CONCLUSIONS A total of 21.2% of patients with IE presented neurological complications, with ischaemic stroke being the most frequent. Neurological symptoms as the initial manifestation of IE did not lead to a delay in diagnosis.
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Affiliation(s)
- J Rodríguez-Montolio
- Servicio de Neurología del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
| | - D Meseguer-Gonzalez
- Servicio de Cardiología del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - M Almeida-Zurita
- Servicio de Neurología del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - P Revilla-Martí
- Servicio de Cardiología del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - S Santos-Lasaosa
- Servicio de Neurología del Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
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Chen L, Liu Y, Jiang J, Fang Q, Zhang Q. Acute ischemic stroke with a diagnosis of Marfan syndrome: A report of 3 cases in multifaceted settings. Medicine (Baltimore) 2024; 103:e37924. [PMID: 38728516 PMCID: PMC11081609 DOI: 10.1097/md.0000000000037924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/28/2024] [Indexed: 05/12/2024] Open
Abstract
RATIONALE Marfan syndrome (MFS), which is a dominantly inherited connective tissue disease resulting from a mutation in the FBN1 gene, exhibits variable manifestations affecting the cardiovascular, musculoskeletal, ophthalmologic, and pulmonary systems. Notably, neurologic deficiency, which involves ischemic or hemorrhagic stroke, is a rare but severe manifestation. The safety of rt-PA treatment for ischemic stroke caused by MFS is still under discussion. PATIENT CONCERNS In the current report, we discuss 3 atypical MFS cases presented as acute ischemic stroke, compared to those exhibiting cardiovascular and musculoskeletal abnormalities. DIAGNOSES Three patients were diagnosed with acute ischemic stroke accompanied by MFS based on clinical manifestations, imaging examinations, and genetic testings. INTERVENTIONS The first case underwent intravenous thrombolytic therapy with rt-PA, the second case received antiplatelet therapy, and the third case received anticoagulant therapy and perfusion therapy. OUTCOMES The neurologic deficiency of all three patients showed improvement upon discharge, and there were no symptoms of recurrence observed during the follow-up period. LESSONS SUBSECTIONS MFS is a rare etiology in young people with embolic stroke of undetermined source. Physicians should take MFS into consideration when they observe the characteristic symptoms during a consultation. The potential pathogenesis of ischemic stroke secondary to MFS may include cardio-embolism, arterial dissection, and hypoperfusion. Although intravenous thrombolysis is a promising therapy to treat acute ischemic stroke, further examinations should be conducted to rule out contraindications in patients with a suspicion of MFS.
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Affiliation(s)
- Licong Chen
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yuan Liu
- Department of Neurology, Suzhou Ninth People’s Hospital, Suzhou, Jiangsu, China
| | - Jianhua Jiang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Qi Fang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Quanquan Zhang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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Albanna AJ, Jumah A, Agarwal U, Fana M, Kareem SA, Miller D. Anticoagulation Therapy in a Patient who had two Consecutive Strokes After Antibiotic Therapy for Infective Endocarditis: A Case Report. Neurohospitalist 2024; 14:204-207. [PMID: 38666280 PMCID: PMC11040627 DOI: 10.1177/19418744231224061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
A 77-year-old male presented with altered mentation and was diagnosed with infective endocarditis. Echocardiography revealed aortic valve vegetations. While receiving inpatient antibiotic therapy, the patient experienced an acute ischemic stroke. Magnetic resonance imaging of the brain showed punctate embolic-appearing infarcts in the right cerebellum and in the left occipital, frontal, and parietal lobes. Anticoagulation was not initiated due to a high risk of hemorrhagic transformation. He was readmitted after being discharged due to another episode of altered mentation. Repeat echocardiography indicated increased size of aortic valve vegetations. The patient was then transferred to our hospital for surgical intervention of enlarging vegetations, however was deemed unsuitable for surgery. During hospitalization, he suffered another embolic stroke in the right frontal lobe. By this time, the patient had completed a full course of antibiotics for infective endocarditis, and additional antibiotics were deemed unnecessary by our infectious disease specialists. Literature review highlighted that residual vegetations carry a higher risk for stroke, but no clear guidelines were found on how to intervene or assess the risk of hemorrhage with anticoagulation in this population. Consequently, a decision was made to initiate anticoagulation, Follow-up imaging revealed no evidence of hemorrhagic transformation. Subsequently, the patient remained stable and was discharged to a rehabilitation center, where he did not experience any further events.
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Affiliation(s)
| | - Ammar Jumah
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Utkarsh Agarwal
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | - Michael Fana
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
| | | | - Daniel Miller
- Department of Neurology, Henry Ford Hospital, Detroit, MI, USA
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5
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Arias Velásquez CA, Quiroz Álvarez JE, Urrego Callejas T. Vasculitis and cerebral hemorrhage due to Streptococcus gordonii infectious endocarditis: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241228410. [PMID: 38292878 PMCID: PMC10826401 DOI: 10.1177/2050313x241228410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/08/2024] [Indexed: 02/01/2024] Open
Abstract
Infective endocarditis is an infection of the heart with systemic consequences, both infectious and non-infectious. Infective endocarditis can affect several systems, one of which is the central nervous system. The most common form of presentation is ischemic stroke; however, intracranial hemorrhage can occur due to immune-mediated damage to the vessel wall. The former further complicates cardiac surgical procedures when necessary. We present here the case of a 21-year-old male patient, with no personal medical history, who presented with intracranial hemorrhage due to a vasculitis phenomenon, caused by Streptococcus gordonii infective endocarditis. The patient underwent emergency drainage of the intracranial hemorrhage and minimally invasive valve surgery in 17 days, with satisfactory postoperative recovery and follow-up.
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Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 242] [Impact Index Per Article: 242.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
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7
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Alawieh AM, Dimisko L, Newman S, Grossberg JA, Cawley CM, Pradilla G, Samuels O, Barrow DL, Howard BM. Management and Long-Term Outcomes of Patients With Infectious Intracranial Aneurysms. Neurosurgery 2023; 92:515-523. [PMID: 36700696 PMCID: PMC10158861 DOI: 10.1227/neu.0000000000002235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 09/13/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Infectious intracranial aneurysms (IIAs) are rare complications of infective endocarditis (IE). Data on management and long-term outcomes remain limited. OBJECTIVE To retrospectively study long-term outcomes of IIAs in patients treated medically or surgically. METHODS Adult cases of IE and/or IIAs admitted to Emory or Grady Healthcare Systems between May 2015 and May 2020 were reviewed for demographic, clinical, and radiographic variables for up to 2 years. Primary outcome measure was 2-year survival. RESULTS Among 1714 cases of IE, intracerebral hemorrhage occurred in 322 patients and IIAs in 17 patients. The presence of IIAs in IE was associated with higher odds of disposition to hospice/death (odds ratio = 6.9). Including non-IE patients, 24 patients had 38 IIAs mainly involving the distal middle cerebral artery and 16 were ruptured on admission. IIAs were predominantly treated with antibiotics as the primary approach. Open microsurgery was the primary approach for 5 aneurysms and was used as salvage in 7 IIAs. Endovascular management was the primary approach for 2 IIAs and used as salvage for 5 IIAs with antibiotic failure. Medical management had high rate of treatment failure (15/31) which predominantly occurred within 2 weeks of onset. The 2-year survival in this cohort was 70% (17/24). CONCLUSION IIAs are rare complications of IE with a poor prognosis. Patients treated with antibiotics have higher risk of treatment failure requiring salvage surgical or endovascular intervention. Medical treatment failure occurred mostly within 2 weeks of onset and had a negative prognostic value emphasizing the need for close follow-up and early surgical or endovascular management.
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Affiliation(s)
| | | | - Sarah Newman
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jonathan A. Grossberg
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C. Michael Cawley
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gustavo Pradilla
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Owen Samuels
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Daniel L. Barrow
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Brian M. Howard
- Department of Neurosurgery, Emory University School of Medicine, Atlanta, Georgia, USA
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8
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Rodríguez-Montolio J, Meseguer-Gonzalez D, Almeida-Zurita M, Revilla-Martí P, Santos-Lasaosa S. Prevalencia de las complicaciones neurológicas en la endocarditis infecciosa. Neurologia 2022. [DOI: 10.1016/j.nrl.2021.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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9
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Yang Y, Qidwai U, Burton BJL, Canepa C. Bilateral, vertical supranuclear gaze palsy following unilateral midbrain infarct. BMJ Case Rep 2020; 13:13/11/e238422. [PMID: 33148560 PMCID: PMC7643481 DOI: 10.1136/bcr-2020-238422] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.
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Affiliation(s)
- Yunfei Yang
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Umair Qidwai
- James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Benjamin J L Burton
- James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
| | - Carlo Canepa
- James Paget University Hospital, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK
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10
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Consoli A, Coskun O, Perier M, Di Maria F, Gratieux J, Dean P, Pizzuto S, Badat N, Condette-Auliac S, Boulin A, Rodesch G. [Therapeutic and endovascular management of cerebral mycotic aneurysms]. Ann Cardiol Angeiol (Paris) 2020; 69:411-414. [PMID: 33131724 DOI: 10.1016/j.ancard.2020.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/04/2020] [Indexed: 11/15/2022]
Abstract
Infective endocardites are associated with both ischemic and hemorrhagic neurological complications and also with cerebral abscesses and the development of "mycotic" aneurysms, which are detected in about 5 % of patients in the acute and sub-acute phase of the infection. Data about their natural history and their hemorrhagic risk are scarce and fragmented. The therapeutic management is represented by the medical treatment of the infection with interventional abstention, the surgical treatment and the endovascular approach by selective embolization of the aneurysm. No evidence is provided concerning the superiority of a specific approach. Mycotic aneurysms remain a diagnostic and therapeutic challenge and their management is necessarily based on a multidiscplinary approach.
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Affiliation(s)
- A Consoli
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France.
| | - O Coskun
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - M Perier
- Service de cardiologie, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - F Di Maria
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - J Gratieux
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - P Dean
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - S Pizzuto
- Unité de neuroradiologie, ospedale Civile S.Agostino-Estense, CHU Modène, université de Modène et Reggio Emilia, Via Pietro Giardini 1355, Modène, Baggiovara, 41126, Italie
| | - N Badat
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - S Condette-Auliac
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - A Boulin
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
| | - G Rodesch
- Service de neuroradiologie diagnostique et thérapeutique, hôpital Foch, 40, rue Worth, 92151, Suresnes, France
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Sgreccia A, Carità G, Coskun O, Maria FD, Benamer H, Tisserand M, Scemama A, Rodesch G, Lapergue B, Consoli A. Acute ischemic stroke treated with mechanical thrombectomy and fungal endocarditis: A case report and systematic review of the literature. J Neuroradiol 2020; 47:386-392. [DOI: 10.1016/j.neurad.2019.03.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/27/2018] [Accepted: 03/15/2019] [Indexed: 11/27/2022]
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Sheibani H, Salari M, Azmoodeh E, Kheirieh A, Chaghazardi S. Culture-negative endocarditis with neurologic presentations and dramatic response to heparin: a case report. BMC Infect Dis 2020; 20:476. [PMID: 32631238 PMCID: PMC7339518 DOI: 10.1186/s12879-020-05206-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 06/29/2020] [Indexed: 12/11/2022] Open
Abstract
Background Blood culture-negative endocarditis (BCNE) is diagnosed in 2–7% of patients with infective endocarditis (IE) and recent antibiotic use is a known risk factor. Altered mental status may be a presenting symptom. Besides empiric antibiotics, intravenous anticoagulation using heparin may have a role in the management of such patients. Case presentation A 23-year-old male patient was referred to our center with fever, altered mental status and abnormal gait. Neurologic examination revealed Wernicke’s aphasia. Cardiac auscultation revealed systolic murmur at the left sternal border. ECG (electrocardiogram) was unremarkable. Brain MRI showed multiple cerebellar lesions. Transthoracic echocardiography (TTE) demonstrated three large masses on the right ventricle (RV), tricuspid valve (TV), and anterior mitral valve (MV) leaflet. Blood cultures (three sets) were negative. Intravenous heparin therapy was administered. After 48 h, the second TTE demonstrated that one valvular lesion disappeared and the other two lesions showed a significant decrease in size. The patient’s neurological symptoms resolved gradually. Further workup for collagen vascular disorders did not show any abnormality. Conclusion BCNE should be considered in patients with fever and neurologic manifestations. TTE should be performed to detect valvular abnormalities. Intravenous heparin could be used in such patients when TTE demonstrate valvular vegetations.
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Affiliation(s)
- Hossein Sheibani
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Science, 3616911151, Imam Ave, Shahroud, Iran.
| | - Mohammad Salari
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Science, 3616911151, Imam Ave, Shahroud, Iran
| | - Elham Azmoodeh
- Student Research Committee, School of Medicine, Shahroud University of Medical Science, Shahroud, Iran
| | - Amirhessam Kheirieh
- Student Research Committee, School of Medicine, Shahroud University of Medical Science, Shahroud, Iran
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Abstract
PURPOSE OF REVIEW Stroke continues to be a leading cause of debility in the world. Infections have been associated with stroke, but are not considered as directly causal, and so they are not often included in the traditional stroke workup and management. They are especially important in patients with stroke of undetermined etiology, and in certain patient populations, such as young patients without traditional risk factors, and immunocompromised patients. RECENT FINDINGS There has been strong evidence for infectious conditions, such as endocarditis, and pathogens, such as varicella zoster in stroke causation, and more supportive evidence is surfacing in recent years of several organisms increasing the stroke risk or being directly causal in stroke. The evidence also seems to be pointing to the role of inflammation in increasing the risk of stroke via accelerated atherosclerosis, vasculitis and vasculopathy. SUMMARY Infectious causes should be considered in the differential and work up of stroke in certain patient populations and appropriate treatments need to be initiated to minimize adverse stroke-related outcomes.
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Brigandi’ A, Terranova C, Toscano A, Vita G. Acute ischemic stroke due to endocarditis from Brucella infection. Neurol Sci 2020; 41:953-954. [DOI: 10.1007/s10072-019-04085-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
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15
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Infections causing stroke or stroke-like syndromes. Infection 2020; 48:323-332. [PMID: 32239441 DOI: 10.1007/s15010-020-01415-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 03/20/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Stroke has relevant morbidity and mortality despite appropriate treatments and early diagnosis. Beside common risk factors such as diabetes and atrial fibrillation, infections can be involved in stroke pathogenesis, probably causing a systemic release of cytokines and other inflammatory mediators, triggering a latent pro-thrombotic state or damaging the vascular endothelium. In other cases, infections can occur as stroke-like syndromes, requiring a high grade of suspicion to avoid a delay in establishing a correct diagnosis. RESULTS Treatment of stroke or stroke-like syndromes of infectious origin can be difficult. When a previous infective event triggers stroke, Alteplase administration can be associated with a higher incidence of bleeding and the extension of the ischaemic area can be major than expected. On the other hand, when stroke is part of some infectious diseases' presentation as in endocarditis, bacterial or tuberculous meningitis and meningo-vascular syphilis, a correct diagnosis can be difficult. The management of these stroke-like syndromes is not standardised because common treatments proven to be effective for patients with stroke of vascular origin can worsen the prognosis, as it can be demonstrated after to be incorrect Alteplase administration to patients with endocarditis with septic embolism to the brain is associated with an increase of the risk of haemorrhage. CONCLUSIONS Stroke or stroke-like syndrome of infectious origin can be observed in an important proportion of case presenting with sensory-motor deficit of unknown origin; their accurate diagnosis has a considerable impact in terms of treatment choices and outcome.
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Kadam M, Birns J, Bhalla A. The management of infective endocarditis complicated by stroke. Int J Clin Pract 2020; 74:e13469. [PMID: 31877574 DOI: 10.1111/ijcp.13469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/21/2019] [Accepted: 12/22/2019] [Indexed: 12/18/2022] Open
Affiliation(s)
- Mustafa Kadam
- Department of Aging and Health, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Jonathan Birns
- Department of Aging and Health, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | - Ajay Bhalla
- Department of Aging and Health, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
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17
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Xu N, Fu Y, Wang S, Li S, Cai D. High level of D-dimer predicts ischemic stroke in patients with infective endocarditis. J Clin Lab Anal 2020; 34:e23206. [PMID: 32017240 PMCID: PMC7246349 DOI: 10.1002/jcla.23206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/08/2019] [Accepted: 12/18/2019] [Indexed: 12/11/2022] Open
Abstract
Background Ischemic stroke is one of the most prominent and serious neurological complications of infective endocarditis (IE). Our study was designed to evaluate the predictive value of higher level of plasma D‐dimer on admission for the development of ischemic stroke in patients with IE. Methods In this prospective study, a total of 173 consecutive patients with IE were recruited from January 2016 to December 2018. Plasma D‐dimer and other clinical indexes of IE patients were measured after admission. The number of patients who developed ischemic stroke during 6‐month follow‐up was recorded, as well as the occurrence time of ischemic stroke. Results Ischemic stroke was observed in 38 (22%) patients during 6‐month follow‐up since definite diagnosis of IE. Patients with ischemic stroke had significantly higher levels of plasma D‐dimer than those of patients without stroke (4982 vs 2205 μg/L, P < .001). In addition, Staphylococcus aureus infection (HR: 1.96, 95% CI: 1.51‐2.42), mitral valve vegetation (HR: 1.52, 95% CI: 1.32‐1.75), and higher levels of on‐admission plasma D‐dimer (HR: 1.35, 95% CI: 1.27‐1.43) were significantly associated with ischemic stroke. Moreover, D‐dimer levels ≥3393 μg/L served as a strong predictor for ischemic stroke in patients with IE, and the sensitivity and specificity were 78% and 83%, respectively. Conclusion Our study suggested that higher level of D‐dimer on admission was an independent predictor for ischemic stroke in patients with IE. These patients may require special attention, in particular within the first trimester after IE diagnosis.
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Affiliation(s)
- Nan Xu
- Department of Infectious Diseases, Tianjin Medical University General Hospital, Tianjin, China
| | - Yakun Fu
- NHC Key Laboratory of Hormones and Development (Tianjin Medical University), Tianjin Key Laboratory of Metabolic Diseases, Tianjin Medical University Chu Hsien-I Memorial Hospital & Tianjin Institute of Endocrinology, Tianjin, China
| | - Shuanglin Wang
- Department of Cardio-Thoracic Surgery, Tianjin Medical University General Hospital, Tianjin, China
| | - Shenghui Li
- Department of Neurosurgery, Key Laboratory of Post-Neurotrauma Neurorepair and Regeneration in Central Nervous System Ministry of Education in China and Tianjin, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Dong Cai
- Department of Cardiology, Tianjin Medical University General Hospital, Tianjin, China
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Mantero V, Rigamonti A, Basilico P, Sangalli D, Scaccabarozzi C, Salmaggi A. Stroke in a Feverish Patient with COVID-19 Infection and Unknown Endocarditis. J Clin Neurol 2020; 16:707-708. [PMID: 33029982 PMCID: PMC7541976 DOI: 10.3988/jcn.2020.16.4.707] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/15/2020] [Accepted: 06/16/2020] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | - Paola Basilico
- Neurology Unit, “A. Manzoni” Hospital-ASST Lecco, Lecco, Italy
| | - Davide Sangalli
- Neurology Unit, “A. Manzoni” Hospital-ASST Lecco, Lecco, Italy
| | | | - Andrea Salmaggi
- Neurology Unit, “A. Manzoni” Hospital-ASST Lecco, Lecco, Italy
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Ren Z, Mo X, Chen H, Peng J. A changing profile of infective endocarditis at a tertiary hospital in China: a retrospective study from 2001 to 2018. BMC Infect Dis 2019; 19:945. [PMID: 31703633 PMCID: PMC6842136 DOI: 10.1186/s12879-019-4609-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 10/31/2019] [Indexed: 02/08/2023] Open
Abstract
Background Infective endocarditis (IE) is a lethal disease which has been changing significantly over the past decades; however, information about IE in China remains scarce. This study surveyed the changes in clinical characteristics of IE at a tertiary hospital in south China over a period of nearly 18 years. Methods Medical records with IE patients consecutively hospitalized between June 2001 and June 2018 were selected from the electronic medical records system in Nanfang Hospital of Southern Medical University. Data were divided by admission time into two groups equally: early-period group, June 2001 to December 2009 and later-period group, January 2010 to July 2018. Results A Total of 313 IE patients were included in our study. Compared with the early-period group, patients in the later-period group included fewer intravenous drug users (IVDUs), older age at onset, reduced development of pulmonary embolism, less renal dysfunction, decreased proportion of Staphylococcus aureus infection and fewer vegetations observed in the right heart by echocardiography. The later-period group also showed a higher proportion of ischemic strokes and higher proportion of positive microbiological findings compared with the early-period group. The in-hospital mortality remained about the same between the two periods and the multivariate analysis identified intravenous drug addicted, prosthetic valve endocarditis, hemorrhagic stroke, acute congestive heart failure, renal insufficiency, left-sided endocarditis, early surgical as independent predictors of in-hospital mortality. Conclusions Our study demonstrated a dramatic change in the profile of IE over a period of 18 years at a tertiary hospital in south China and presented several independent predictors of in-hospital mortality. The geographic variations observed in our study will be of important value to profile the clinical feature of China and offer the reference for clinical decisions in our region.
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Affiliation(s)
- Zuning Ren
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xichao Mo
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Hongjie Chen
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jie Peng
- Department of Infectious Diseases, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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20
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Sotero FD, Rosário M, Fonseca AC, Ferro JM. Neurological Complications of Infective Endocarditis. Curr Neurol Neurosci Rep 2019; 19:23. [PMID: 30927133 DOI: 10.1007/s11910-019-0935-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The purpose of this narrative review and update is to summarize the current knowledge and provide recent advances on the neurologic complications of infective endocarditis. RECENT FINDINGS Neurological complications occur in about one-fourth of patients with infective endocarditis. Brain MRI represents a major tool for the identification of asymptomatic lesions, which occur in most of the patients with infective endocarditis. The usefulness of systematic brain imaging and the preferred treatment of patients with infective endocarditis and silent brain lesions remains uncertain. The basis of treatment of infective endocarditis is early antimicrobial therapy. In stroke due to infective endocarditis, anticoagulation and thrombolysis should be avoided. Endovascular treatment can be useful for both acute septic emboli and mycotic aneurysms, but evidence is still limited. In patients with neurological complications, cardiac surgery can be safely performed early, if indicated. The optimal management of a patients with neurological complications of infective endocarditis needs an individualized case discussion and the participation of a multidisciplinary team including neurologists, cardiologists, cardiothoracic surgeons, neuroradiologists, neurosurgeons, and infectious disease specialists.
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Affiliation(s)
- Filipa Dourado Sotero
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Madalena Rosário
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal
| | - Ana Catarina Fonseca
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal.,Faculdade de Medicina, Hospital de Santa Maria, Universidade de Lisboa, Neurology 6th floor, Avenida Professor Egas Moniz s/n, 1649-035, Lisbon, Portugal
| | - José M Ferro
- Department of Neurosciences and Mental Health, Neurology Service, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal. .,Faculdade de Medicina, Hospital de Santa Maria, Universidade de Lisboa, Neurology 6th floor, Avenida Professor Egas Moniz s/n, 1649-035, Lisbon, Portugal.
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Ng PC, Long B, Koyfman A. Clinical chameleons: an emergency medicine focused review of carbon monoxide poisoning. Intern Emerg Med 2018; 13:223-229. [PMID: 29435715 DOI: 10.1007/s11739-018-1798-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 02/01/2018] [Indexed: 12/21/2022]
Abstract
Carbon monoxide (CO) is a colorless, odorless gas that is found in the environment, in the home, and in the human body as a normal part of mammalian metabolism. Poisoning from CO, a common exposure, is associated with significant morbidity and mortality if not recognized and treated in a timely manner. This review evaluates the signs and symptoms of CO poisoning, conditions that present similar to CO poisoning, and an approach to the recognition and management for CO poisoning. CO poisoning accounts for thousands of emergency department visits annually. If not promptly recognized and treated, it leads to significant morbidity and mortality. CO poisoning poses a challenge to the emergency physician because it classically presents with non-specific symptoms such as headache, dizziness, nausea, and vomiting. Due to nonspecific presentations, it is easily mistaken for other, more benign diagnoses such as viral infection. The use of specific historical clues such as exposure to non-conventional heat sources or suicide attempts in garages, as well as the use of targeted diagnostic testing with CO-oximetry, can confirm the diagnosis of CO poisoning. Once diagnosed, treatment options range from observation to the use of hyperbaric oxygen. CO poisoning is an elusive diagnosis. This review evaluates the signs and symptoms CO poisoning, common chameleons or mimics, and an approach to management of CO poisoning.
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Affiliation(s)
- Patrick Chow Ng
- Medical Toxicology, Rocky Mountain Poison and Drug Center, Denver Health and Hospital, 1391 Speer Blvd, Denver, CO, 80204, USA.
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Dr, Fort Sam Houston, San Antonio, TX, 78234, USA
| | - Alex Koyfman
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
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Alawieh A, Chaudry MI, Turner RD, Turk AS, Spiotta AM. Infectious intracranial aneurysms: a systematic review of epidemiology, management, and outcomes. J Neurointerv Surg 2018; 10:708-716. [DOI: 10.1136/neurintsurg-2017-013603] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 01/16/2018] [Accepted: 01/24/2018] [Indexed: 12/27/2022]
Abstract
Infectious intracranial aneurysms (IIAs) are a rare cerebrovascular complication of systemic infections induced by microbial infiltration and degradation of the arterial vessel wall. Studies on the epidemiology and management of IIAs are limited to case reports and retrospective single-center studies, and report a large variability in epidemiological features, management, and outcomes due to the limited sample size. We conducted a systematic review of all published papers on IIAs in the English literature using MEDLINE and SCOPUS database from January 1950 to June 2017. A total of 288 publications describing 1191 patients with IIA (1398 aneurysms) were included and reviewed for epidemiological features, disease features, treatment and outcome. All patients were merged into a single cohort and summary data are presented. The majority of reported IIAs are distally located, relatively small (<5 mm), involve the anterior circulation, are associated with a relatively high rate of rupture, and demonstrate a propensity to multiplicity of aneurysms. Sensitive diagnosis of IIAs requires digital subtraction angiography and not CT angiography or MR angiography. Treatment of ruptured, symptomatic, or enlarging IIAs has evolved over the last 50 years. Endovascular therapy is associated with a high success rate and low morbidity compared with microsurgical and medical management. A treatment algorithm for the management of patients with IIA in various contexts is proposed and the need for prospective multicenter studies is emphasized.
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Jennings R, Hammersley D, Hancock J, Blauth C. The diagnostic and therapeutic challenges of infective endocarditis presenting as acute stroke. BMJ Case Rep 2017; 2017:bcr-2017-219762. [PMID: 28473364 DOI: 10.1136/bcr-2017-219762] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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