Intracranial haemorrhage in infective endocarditis

Abstract

ICH is a common complication of left-sided IE. The impact on prognosis is dependent on mechanism (haemorrhage of undetermined aetiology). We observed a higher mortality rate in patients who had conservative treatment when cardiac surgery was indicated compared with in those who underwent cardiac surgery.

Intracerebral haemorrhage: from clinical settings to animal models

“…13 The major high-risk factors for ICH are an elderly population, 14 male sex, 15 current smoking, 16 excessive alcohol consumption, 17 low total cholesterol level, 18 long sleep duration, 19 illicit drug use, 20 Asians ethnic origin 21 and genetic factors. 22 Other clinical disease can cause ICH, including hypertension, 23 coagulopathy, 24 cerebral amyloid angiopathy (CAA), 25 cerebral tumours, 26 intracranial arterial aneurysm, 27 vascular anomalies, 28 brain trauma, 29 premature birth, 30 haemorrhagic conversion of stroke, 31 posterior reversible encephalopathy syndrome, 32 vasculitis, 33 infective endocarditis, 34 dural arteriovenous fistula, 35 brain arteriovenous malformation, 36 cavernous malformation 37 and intracranial venous thrombosis 38 (figure 1). ICH associated with hypertension remains the most common form of ICH.…”

Neurological Complications of Endocarditis: A Multidisciplinary Review with Focus on Surgical Decision Making

“…21 While ischemic strokes are thought to be caused by migration of a macroscopic fragment of the vegetation which occludes cerebral arteries, IIA and intracranial hemorrhage (ICH) are likely due to microembolisms or bacterial translocation which evolves into pyogenic necrosis and microabscess in the arterial wall. 22 An autoimmune process may mediate a localized smallvessel vasculitis after septic embolization. Magnetic resonance imaging (MRI) patterns support this hypothesis, as septic emboli are frequently associated with cerebral microbleeding (CMB), and small ischemic lesions of different ages similar to primary CNS vasculitis.…”

“…In a recent large series, the most common cause was hemorrhagic conversion of an ischemic stroke (40%), followed by rupture of IIA (32%). 22 Several factors increase the risk for ICH in IE, including thrombocytopenia (<150 Â 109/L), severe valve regurgitation, ischemic stroke, presence of IIA, prior symptomatic embolism, and anticoagulant use at admission. 8,22 In-hospital mortality in IE-associated hemorrhagic stroke traditionally has been reported to be as high as 52%.…”

“…22 Several factors increase the risk for ICH in IE, including thrombocytopenia (<150 Â 109/L), severe valve regurgitation, ischemic stroke, presence of IIA, prior symptomatic embolism, and anticoagulant use at admission. 8,22 In-hospital mortality in IE-associated hemorrhagic stroke traditionally has been reported to be as high as 52%. 27,31,32 However, small single-center studies have shown this is not uniformly the case.…”

“…In one study of 68 patients, the mortality of patients with ICH was not increased at 1 year compared with others with IE without hemorrhage. 22 Improved imaging techniques for diagnosis and the more widespread adoption of endovascular procedures are likely contributing to improved outcomes.…”