Nervous system complications in bacterial endocarditis.

Abstract

<h2>Abstract</h2> Neuropsychiatric complications are common in bacterial endocarditis, and if sought for may be found in up to 40 to 50 per cent of patients. The nervous system is involved as frequently in the present era as in the decades prior to the introduction of antibiotics. Any acute neurologic syndrome or psychiatric illness arising in a patient with a fever and a cardiac murmur in the absence of arrhythmia should suggest bacterial endocarditis. Complications are mainly due to infected emboli; meningoencephalitis is the most common complication, but overt embolus and mycotic aneurysm are not rare. Brain abscesses are a more common complication in acute than in subacute bacterial endocarditis; the antibiotic era has seen an apparent decline in the incidence of this complication. Other, less well characterised, pathologic complications include cerebral micro-infarcts, purpura and edema as well as endarteritis with thrombosis or stenosis. A wide range of presentations can result from the cerebral lesions, the most dramatic being hemiplegia, aphasia, cranial nerve paralysis, cerebral hemorrhage and subarachnoid hemorrhage. The relatively common minor symptoms, such as headache or confusion, may portend a more serious outcome. The cerebrospinal fluid frequently shows abnormalities following embolisation of the brain. Although the usual finding is a sterile meningitis, a more serious underlying lesion may be present: in particular, a mycotic aneurysm may present as a sterile meningitis with few or no red blood cells appearing in the cerebrospinal fluid. Full investigation of sterile meningitis during the course of bacterial endocarditis should include cerebral angiography. since mycotic aneurysms frequently can be resected. Management of the cerebral complications of bacterial endocarditis does not, in general, require any departure from the usual treatment of endocarditis, but neurosurgical intervention may be required for mycotic aneurysms or cerebral abscesses.