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Handb Clin Neurol. 2014;119:75-91. doi: 10.1016/B978-0-7020-4086-3.00007-2.

Infective endocarditis.

Author information

1
Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal. Electronic address: jmferro@fm.ul.pt.
2
Department of Neurosciences, Serviço de Neurologia, Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal.

Abstract

Infective endocarditis is a serious disease of the endocardium of the heart and cardiac valves, caused by a variety of infectious agents, ranging from streptococci to rickettsia. The proportion of cases associated with rheumatic valvulopathy and dental surgery has decreased in recent years, while endocarditis associated with intravenous drug abuse, prosthetic valves, degenerative valve disease, implanted cardiac devices, and iatrogenic or nosocomial infections has emerged. Endocarditis causes constitutional, cardiac and multiorgan symptoms and signs. The central nervous system can be affected in the form of meningitis, cerebritis, encephalopathy, seizures, brain abscess, ischemic embolic stroke, mycotic aneurysm, and subarachnoid or intracerebral hemorrhage. Stroke in endocarditis is an ominous prognostic sign. Treatment of endocarditis includes prolonged appropriate antimicrobial therapy and in selected cases, cardiac surgery. In ischemic stroke associated with infective endocarditis there is no indication to start antithrombotic drugs. In previously anticoagulated patients with an ischemic stroke, oral anticoagulants should be replaced by unfractionated heparin, while in intracranial hemorrhage, all anticoagulation should be interrupted. The majority of unruptured mycotic aneurysms can be treated by antibiotics, but for ruptured aneurysms, endovascular or neurosurgical therapy is indicated.

KEYWORDS:

Endocarditis; anticoagulation; embolism; encephalopathy; mycotic aneurysm; stroke; valve surgery

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