Neurologic complications of infective endocarditis: A four's year experience of Casablanca university hospital

Abstract

Clinical manifestations of infective endocarditis(IE) include systemic, cardiac, and extracardiac multiorgan symptoms and signs. Hence, neurological complications have been linked to poor outcome and remains the most frequent extracardiac signs of IE with 25% of patients experience at least one neurological event. To assess the incidence of neurological complications in patients with infective endocarditis, the risk factors for their development and their influence on the clinical outcome. Retrospective study included patients with possible or definite infective endocarditis according to the European society of cardiology modified Duke Criteria, admitted between 2016 and 2019 in the Cardiology department of Casablanca university. Seventy-one patients were male and 47 were female with a mean (SD) age = 40.3 (15.2) years. 85 episodes were designed as definite IE. Neurologic complications were identified in 24,5% patients with 22 events associated with definite IE. Nineteen complications were thought to be caused by major cerebral embolism including ischemic brain infarction and transient ischemic stroke. On the other hand, cerebral hemorrhage was found in 6 patients and no significant association between anticoagulation therapy and cerebral hemorrhage was found in our study. Neurologic complications were significantly associated with Staphylococcus aureus infection ( P = 0.017) and with IE affecting both the aortic and the mitral valves ( P = 0.03). Death during the acute phase of IE occurred in 8 episodes (30%) with neurologic complications and in 9 episodes (10%) without neurologic complications. Mortality was highly associated with neurologic complications with a P = 0.017. Our results reinforce that neurologic complications has negative impact on the outcome of patients with IE. Furthermore, appropriate antimicrobial therapy should be instituted rapidly to prevent neurologic events and reduce mortality rate.