Stroke, Vol 21, 695-700, Copyright © 1990 by American Heart Association
RG Hart, JW Foster, MF Luther and MC Kanter
We reviewed 212 consecutive episodes of infective endocarditis in 203
patients at six hospitals between 1978 and 1986 and found that 21% were
complicated by stroke. Of 133 episodes involving native mitral and/or
aortic valves, brain ischemia occurred in 19%, brain hemorrhage in 7%, and
non-central nervous system emboli in 11%; vegetations were identified in
56% of 113 adequate echocardiograms and did not correlate with risk of
embolism. In native-valve endocarditis, most (74%) ischemic strokes had
occurred by the time of presentation and an additional 13% occurred less
than or equal to 48 hours after diagnosis; the incidence of brain ischemia
was 13% on presentation, 3% during the first 48 hours of hospitalization,
and 2%-5% during the remainder of the acute course. Stroke recurred at a
rate of 0.5%/day, often heralding relapse/uncontrolled infection. Only 9%
of ischemic infarcts were large (all in patients with Staphylococcus aureus
infection), while 8% were small and subcortical. Brain hemorrhage occurred
primarily at the time of presentation, particularly in intravenous drug
abusers, and was associated with uncontrolled S. aureus infection with
pyogenic arteritis. Ischemic and hemorrhagic stroke continue to be frequent
and important in patients with infective endocarditis and are clustered
during uncontrolled infection.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Stroke in infective endocarditis
Department of Medicine (Neurology), University of Texas Health Science Center, San Antonio 78284.
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