Chapter 13 - Neurological complications of bacterial endocarditis

Abstract

This chapter discusses the epidemiology, etiology, pathogenesis, clinical features, diagnosis, and management of neurological complications of bacterial endocarditis. The most common organisms causing infective endocarditis are viridans streptococci, Streptococcus bovis , the HACEK group, Staphylococcus aureus , and community-acquired enterococci. Infective endocarditis is often classified as acute or subacute based on the pace of the natural evolution of clinical manifestations. Acute infective endocarditis is fulminant and fatal within days to weeks whereas subacute infective endocarditis smolders with nonspecific systemic symptoms and immunological phenomena in the setting of underlying valvular disease. From a neurological perspective, the presence of major embolic events, most of which affect the central nervous system (CNS), represents one of the minor criteria for diagnosis. Diffusion-weighted magnetic resonance imaging (DWI MRI) is the most sensitive imaging modality and allows for additional information on the temporal profile of involvement. Intra-arterial digital subtraction angiography is the gold standard for the diagnosis of cerebral mycotic aneurysms as their small size and peripheral location are typically poorly visualized by magnetic resonance angiography or contrast-enhanced brain computed tomography (CT) scans.