Document Detail

Clinical characteristics and thrombolytic outcomes of infective endocarditis-associated stroke.
MedLine Citation:
PMID:  23983869     Owner:  NLM     Status:  PubMed-not-MEDLINE    
OBJECTIVE: Our aim was to describe the clinical features of infective endocarditis (IE) in the acute stroke setting and outcomes following thrombolytic therapy.
METHODS: This is a single-center, retrospective, descriptive case series of IE-related stroke (IES). Infective endocarditis diagnosis was based on the modified Duke criteria.
RESULTS: From 2001 to 2007, 18 patients with acute stroke had definite or possible IE. Presenting stroke subtypes were: 11 ischemic stroke; 2 intracerebral hemorrhage; and 5 with a combination of ischemia and subarachnoid hemorrhage. On presentation, 6 had objective fever and 5 had subjective fever, 8 had heart murmur, and 3 had classic IE stigmata. The most common laboratory abnormalities were leukocytosis (n = 11) and anemia (n = 10). Sixteen patients had valvular vegetations on echocardiogram; 6 of 8 patients had vegetations visualized on transesophageal echocardiogram that were not detected by transthoracic echocardiogram. Two of the 3 patients with valve replacements had vegetations only on their native valves. Of 11 patients with pure ischemic stroke, 4 received thrombolytics and had hemorrhagic conversion. Overall mortality of IES was 56% (10 of 18). Mortality in pure ischemic IES patients was 29% (2 of 7, median National Institute of Health Stroke Scale [NIHSS] 13) in those not receiving thrombolytics and 75% (3 of 4, median NIHSS 14) in those receiving thrombolytics.
CONCLUSIONS: Though diagnosis of IE in the acute stroke setting is difficult, features of the history, examination, and laboratory data may raise concern for IE. In this case series, thrombolytics in patients with IE-associated stroke were associated with very poor outcomes.
Kevin A Walker; Jacinda B Sampson; Elaine J Skalabrin; Jennifer J Majersik
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Neurohospitalist     Volume:  2     ISSN:  1941-8744     ISO Abbreviation:  Neurohospitalist     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2013-08-28     Completed Date:  2013-08-28     Revised Date:  2014-07-31    
Medline Journal Info:
Nlm Unique ID:  101558199     Medline TA:  Neurohospitalist     Country:  United States    
Other Details:
Languages:  eng     Pagination:  87-91     Citation Subset:  -    
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