Document Detail


Cerebrovascular complications in patients with left-sided infective endocarditis are common: a prospective study using magnetic resonance imaging and neurochemical brain damage markers.
MedLine Citation:
PMID:  18491965     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Background. @nbsp; Cerebrovascular complications (CVCs) have remained a major therapeutic and prognostic challenge associated with infective endocarditis, and definite risk factors have not been fully elucidated. This prospective study was designed to the evaluate the total incidence of CVC associated with infective endocarditis and major risk factors. Methods. @nbsp; During 2 study periods, from June 1998 through April 2001 and from September 2002 through January 2005, patients were prospectively enrolled in the study regardless of neurological symptoms. Study patients underwent neurological examinations and magnetic resonance imaging of the brain, and cerebrospinal fluid analyses of inflammatory and neurochemical markers of brain damage (neurofilament protein and glial fibrillary acidic protein) were performed. Results. @nbsp; Sixty patients who experienced episodes of left-sided infective endocarditis were evaluated; 35% of these patients experienced a symptomatic CVC. Silent cerebral complications were detected in another 30% of the patients, and the total CVC rate was 65% (95% confidence interval, 58%-72%). Five percent of patients experienced their first neurological symptom after the initiation of antibiotic treatment without prior surgery. No new symptomatic CVCs were detected after 10 days of antibiotic treatment. No neurological deterioration was observed after surgery in patients who were established to have a symptomatic CVC preoperatively. A larger heart valvular vegetation size was a risk factor for both symptomatic and silent CVCs; Staphylococcus aureus etiology conferred a higher risk for symptomatic cerebral complication only. Conclusions. @nbsp; The use of sensitive methods of detection indicates that the incidence of CVC associated with infective endocarditis is high, but the risk for neurological deterioration during cardiac surgery after a CVC is lower than previously assumed. The major mechanism behind cerebral complications associated with infective endocarditis is cerebral embolization, although the dominant neurological symptoms vary considerably.
Authors:
Ulrika Snygg-Martin; Lars Gustafsson; Lars Rosengren; Asa Alsiö; Per Ackerholm; Rune Andersson; Lars Olaison
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical infectious diseases : an official publication of the Infectious Diseases Society of America     Volume:  47     ISSN:  1537-6591     ISO Abbreviation:  Clin. Infect. Dis.     Publication Date:  2008 Jul 
Date Detail:
Created Date:  2008-06-04     Completed Date:  2008-07-03     Revised Date:  2008-12-01    
Medline Journal Info:
Nlm Unique ID:  9203213     Medline TA:  Clin Infect Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  23-30     Citation Subset:  IM    
Affiliation:
Departments of 1Infectious Diseases, 2Radiology, and 3Neurology, Sahlgrenska University Hospital, Göteborg, and Departments of 4Infectious Diseases and 5Radiology, and 6Research and Development Center, Skaraborg Hospital, Skövde, Sweden.
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MeSH Terms
Descriptor/Qualifier:
Aged
Anti-Bacterial Agents / therapeutic use
Brain / radiography
Brain Diseases / diagnosis*,  epidemiology*,  pathology,  physiopathology
Cerebrospinal Fluid / chemistry,  immunology
Endocarditis / complications*,  drug therapy,  microbiology,  surgery
Female
Glial Fibrillary Acidic Protein / cerebrospinal fluid
Heart Valves / microbiology
Humans
Incidence
Intracranial Embolism
Magnetic Resonance Imaging
Male
Middle Aged
Neurofilament Proteins / cerebrospinal fluid
Prospective Studies
Risk Factors
Staphylococcal Infections / complications,  microbiology
Staphylococcus aureus / isolation & purification
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 0/Glial Fibrillary Acidic Protein; 0/Neurofilament Proteins
Comments/Corrections
Comment In:
Clin Infect Dis. 2008 Nov 15;47(10):1362; author reply 1362-3   [PMID:  18922076 ]
Clin Infect Dis. 2008 Jul 1;47(1):31-2   [PMID:  18491960 ]

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