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Stroke, Vol 18, 1048-1056, Copyright © 1987 by American Heart Association

ARTICLES

Mechanisms of intracranial hemorrhage in infective endocarditis

RG Hart, K Kagan-Hallet and SE Joerns
Department of Medicine (Neurology), University of Texas Health Science Center, San Antonio 78284.

Analysis of 17 patients with infective endocarditis and intracranial hemorrhage yielded several different mechanisms of bleeding. Nine of 15 (60%) symptomatic intracranial hemorrhages occurred within 48 hours of admission and 3 more (20%) after hospital discharge. In 7 patients with Staphylococcus aureus endocarditis, symptomatic intracranial hemorrhage occurred within 48 hours of admission and resulted from septic arteritis in all 3 examined pathologically. Secondary hemorrhagic transformation (hemorrhagic infarction) was asymptomatic in 2 nonanticoagulated patients but was associated with clinical worsening in 2 anticoagulated patients. Anticoagulation potentially contributed to intracranial hemorrhage in 4 of the 17 patients (24%). Proven mycotic aneurysms were present in only 2 patients (12%), 1 of whom presented with massive, fatal intracranial hemorrhage. Mycotic aneurysms amenable to surgery are uncommon and underlie only a fraction of intracranial hemorrhages in infective endocarditis.

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