Management of Neurological Complications of Infective Endocarditis in Intensive Care Unit Patients

Abstract

Many patients with infective endocarditis may be complicated with neurological events which lead to morbidity and mortality, which perhaps needs to be admitted to the intensive care unit for proper management. These neurological complications may be due to occlusion of cerebral arteries by emboli derived from endocardial vegetation, cerebral hemorrhage and infection of the meninges. Early detection of neurological complications of infective endocarditis, whether by CT scan or MRI on the brain is very important to prevent further and more serious complications, also Echocardiography and transesophageal echocardiography have a well-defined role in the diagnosis and management of embolic events that occur with infective endocarditis. If the neurological complications of IE occur, proper management must be started after proper diagnosis either by medical therapy through antibiotics or anticoagulant therapy or by cardiac surgeries.  69 The risk of symptomatic emboli associated with infective endocarditis was reduced in patients who received continuous daily antiplatelet therapy before onset of infective endocarditis. The safety of cardiopulmonary bypass has been controversially debated for years in patients with neurological complications of infective endocarditis. Anticoagulation during cardiac surgery may increase the risk of hemorrhagic transformation of an asymptomatic ischemic stroke. Moreover, episodes of hypotension during procedure might exacerbate a pre-existing ischemic brain lesion. However, Stroke is not a contraindication for urgent valve replacement in acute infective endocarditis