Abstract TP284: Association of Hemorrhagic Stroke with Recurrence Stroke caused by Infective Endocarditis

Abstract

Objective: Infective endocarditis causes not only brain infarcts and infection triggered by bacterial emboli, but also hemorrhagic stroke by inflamed arteries or aneurysms prone to rupture, when we make the requisite open-heart surgery delayed. We examined if hemorrhagic stroke caused by infective endocarditis and complicated microbleeds were associated with subsequent recurrent stroke. Methods: We conducted the observational study on 36 consecutive patients (19 men, aged 18-84, median 53) with acute symptomatic stroke caused by definite or possible infective endocarditis according to the Duke University criteria from October 2005 to April 2012. Brain hemorrhage/infarcts responsible for neurological signs and asymptomatic microbleeds were verified by CT and diffusion/T2*-weighted MRI. We had followed each patient as for recurrent symptomatic stroke for 3 months. Results: Out of 36, hemorrhagic stroke was noted in 15 patients, 13 of whom had simultaneous infarcts, and the other 21 patients showed pure ischemic stroke and TIA. Fifteen patients had asymptomatic microbleeds. Fourteen patients experienced recurrent stroke, which consisted of SAH in 4, hematoma/massive hemorrhagic transformation from infarcts in 4 and pure infarction in 6. Ten patients (71%) in the recurrent group had hemorrhagic stroke for initial attack, while 5 in 22 (23%) of the non-recurrent group did (p<0.01). The recurrent group had a higher average age (18-82 years, median 68 years) than the non-recurrent group (23-75 years, median 51 years). No statistically significant differences between the non-recurrent and the recurrent groups were observed of a proportion of patients that were female and had, infarction, microbleeds, hypertension, diabetes, antithrombotic treatment, attachment of 10-mm or larger vegetations to damaged valves, isolation of staphylococcus aureus from blood, embolization to other organs than the brain and complication of meningitis/abscess. Conclusions: Hemorrhagic stroke, but not asymptomatic microbleeds, was associated with recurrent stroke after infective endocarditis. Duration of waiting for the safe heart operation after symptomatic hemorrhagic stroke can be in face of recurrent stroke.