Lesions and Symptoms of Stroke Following Infective Endocarditis

Background: Stroke is often one of the presenting symptoms of infective endocarditis (IE) and can result in significant short- and long-term morbidity and mortality. Symptomatic stroke has been reported to occur in 35% of patients with IE, and asymptomatic cerebrovascular complications in another 30%. We aim to analyze symptoms, lesions and risk factors of stroke following IE.

Methods: In this study, patients suffering stroke following infective Endocarditis (n = 81) between 01/2012 and 12/2021 were retrospectively identified and included out of our institutional endocarditis registry (n = 575). Bamford Stroke Scale was used to classify the ischemic strokes. We analyzed the patterns on brain imaging and classified the lesions into 4 categories and further analyzed them according to pathogen and valve type. Data are presented as medians and 25th–75th percentiles, or absolute numbers and percentages.

Results: Patients suffering from strokes hat a significantly higher rate of native mitral valve endocarditis (p = 0.018). There was no difference in the rate of prosthetic valve endocarditis between the groups (p = 0.608). There was no difference observed in the ICU stay (p = 0.560) and in-hospital mortality (p = 0.094) between the groups. The main symptoms were: Motor/Sensory 33/81 (41%); Visual 14/81 (18%), Language 24/81 (29%), Cerebellar 13/81 (16%); Other/Encephalopathy 19/81 (23%); Seizures 4/81 (5%). According to Bamford Stroke Scale Stroke was classified as follows: Total anterior circulation stroke (TACS): 1/81 (1%); Partial anterior circulation stroke (PACS) 25/81 (31%); Posterior circulation syndrome (POCS) 17/81 (21%); Lacunar stroke (LACS) 14/81 (17%); Combined 8/81 (10%); No stroke 33/81 (41%). Brain MRI findings were grouped into 4 patterns: Pattern 1: single lesion suggesting a solitary embolus (n = 7; 8.6%) Pattern 2: multiple closely spaced lesions in a single arterial territory (n = 3; 3.7%) Pattern 3: multiple punctate disseminated lesions (n = 8; 9.8%) Pattern. 4 multiple small and medium or large disseminated lesions (n = 39, 48.1%).

Conclusion: The main symptoms were motor/sensory deficits. According to Bamford stroke scale, partial anterior circulation stroke was the most common form. Native mitral valve endocarditis could be identified as a risk factor for stroke. Prosthetic valve endocarditis could not be identified as a risk factor for stroke. There was no difference observed in the ICU stay and in-hospital mortality between the groups.

Publikationsverlauf

Artikel online veröffentlicht:
13. Februar 2024