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Neurological Complications of Infective Endocarditis

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Neurological Complications of Infectious Diseases

Part of the book series: Current Clinical Neurology ((CCNEU))

Abstract

This chapter provide recent insights in mechanisms and management of neurologic complications in patients with left-sided infective endocarditis (IE). Neurologic complications contribute to a poor prognosis, increasing mortality and morbidity from disabling sequelae.

Cerebral lesions are thought to involve synergistic pathophysiological mechanisms including thromboembolism, sepsis, meningitis and small-vessel cerebral vasculitis.

Symptomatic cerebral ischemic or hemorrhagic events occur in 20–55% of IE patients, but asymptomatic cerebral events are actually detected in the majority (60–80%) of patients undergoing brain MRI. The latter represents a major tool in the management of patients, and can impact therapeutic decisions and prognosis, especially when cardiac surgery is indicated. In patients presenting with neurologic complications, notably ischemic events, recent studies suggest that surgery could be safely performed earlier than previously thought. Altered mental status at IE onset, which is associated with brain injury, constitutes an additional major determinant of short-term outcome.

Other important issues include the appropriate use of anti-infective and antithrombotic agents, and endovascular treatment for mycotic aneurysms, for which uncertainties remain.

Neurologic complications in IE patients remain a serious issue, whose management and diagnosis are challenging, requiring an experienced multidisciplinary team.

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Author information

Authors and Affiliations

  1. Department of Neurology, Saint-Antoine University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France

    Marie Cantier

  2. INSERM U1148, Université Paris Diderot, Paris, France

    Marie Cantier

  3. INSERM U1148, Université Paris Diderot, Sorbonne Paris Cité, Paris, France

    Mikael Mazighi & Romain Sonneville

  4. Department of Neurology, Lariboisière University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France

    Mikael Mazighi

  5. Department of Intensive Care Medicine and Infectious Diseases, Bichat-Claude Bernard University Hospital, Assistance Publique – Hôpitaux de Paris, Paris, France

    Romain Sonneville

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  1. Marie Cantier
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  2. Mikael Mazighi
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Correspondence to Marie Cantier .

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Editors and Affiliations

  1. UT Health McGovern Medical School, Houston, TX, USA

    Rodrigo Hasbun, MD MPH

  2. Div of Infectious Dis, MCN A-2200, Vanderbilt University, Nashville, TN, USA

    Karen C. Bloch, MD MPH

  3. Dept of Infectious Diseases, Apt 635, Cleveland Clinic Foundation, Cleveland, OH, USA

    Adarsh Bhimraj, MD

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Cantier, M., Mazighi, M., Sonneville, R. (2021). Neurological Complications of Infective Endocarditis. In: Hasbun, MD MPH, R., Bloch, MD MPH, K.C., Bhimraj, MD, A. (eds) Neurological Complications of Infectious Diseases. Current Clinical Neurology. Humana, Cham. https://doi.org/10.1007/978-3-030-56084-3_4

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  • DOI: https://doi.org/10.1007/978-3-030-56084-3_4

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