Sonneville et al. Annals of Intensive Care 2011, 1:10 REVIEW Open Access Management of neurological complications of infective endocarditis in ICU patients Romain Sonneville, Bruno Mourvillier, Lila Bouadma and Michel Wolff* Abstract Patients with infective endocarditis (IE) are generally referred to the intensive care unit (ICU) for one or more organ dysfunctions caused by complications of IE. Neurologic events are frequent causes of ICU admission in patients with IE. They can arise through various mechanisms consisting of stroke or transient ischemic attack, cerebral hemorrhage, mycotic aneurysm, meningitis, cerebral abscess, or encephalopathy. Most complications occur early during the course of IE and are a hallmark. | Sonneville et al. Annals of Intensive Care 2011 1 10 http content 1 1 10 Ù Annals of Intensive Care a SpringerOpen Journal REVIEW Open Access Management of neurological complications of infective endocarditis in ICU patients Romain Sonneville Bruno Mourvillier Lila Bouadma and Michel Wolff Abstract Patients with infective endocarditis IE are generally referred to the intensive care unit ICU for one or more organ dysfunctions caused by complications of IE. Neurologic events are frequent causes of ICU admission in patients with IE. They can arise through various mechanisms consisting of stroke or transient ischemic attack cerebral hemorrhage mycotic aneurysm meningitis cerebral abscess or encephalopathy. Most complications occur early during the course of IE and are a hallmark of left-sided abnormalities of native or prosthetic valves. Occlusion of cerebral arteries with stroke or transient ischemic attack accounts for 40 to 50 of the central nervous system complications of IE. CT scan is the most easily feasible neuroimaging in critically unstable patients. However magnetic resonance imaging is more sensitive and when performed should follow a standardized protocol. In patients with ischemic stroke who are already receiving oral anticoagulant therapy this treatment should be replaced by unfractionated heparin for at least 2 weeks with a close monitoring of coagulation tests. Mounting evidence shows that for both complicated left-sided native valve endocarditis and Staphylococcus aureus prosthetic valve endocarditis valve replacement combined with medical therapy is associated with a better outcome than medical treatment alone. In a recent series approximately 50 of patients underwent valve replacement during the acute phase of IE before completion of antibiotic treatment. After a neurological event most patients have at least one indication for cardiac surgery. Recent data from literature suggest that after a stroke surgery indicated .
