Neurological complications of endocarditis: Pathophysiologic mechanisms and management issues

Abstract

Endocarditis is a major threat to the nervous system. Early detection of neurological damage using neuro-imaging and treatment during the pre-embolic phase is essential to prevent serious morbidity and mortality. MRI sequences such as GRE and SWI have great sensitivity to detect microhemorrhages in order to detect systemic sepsis affecting the CNS and subclinical embolic events. In the case of an acute neurological deficit in a patient known to have valvular disease, congenital heart disease or previous valvular surgery, embolization due to endocarditis must be considered high in the differential diagnosis. Serial imaging of the brain and brain vasculature using MRI/MRA and high resolution CT/CTA are required to monitor the formation and progression of infectious intracranial aneurysms. Multi-disciplinary neurovascular consultation is required once infectious intracranial aneurysms have been detected. Once stabilized, infectious intracranial aneurysms often have a good prognosis. Marantic endocarditis is rare. The prognosis often depends mainly on the clinical course of the underlying malignancy. Institutions need to develop and implement structured approaches to the detection and treatment of IE.