Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2018 May 25:9:107.
doi: 10.4103/sni.sni_67_18. eCollection 2018.

Intracranial complications of acute bacterial endocarditis

Burke A Cunha  1   2 , Ismail Jimada  1   2 , Karishma Chawla  1   2
Affiliations
Case Reports

Intracranial complications of acute bacterial endocarditis

Burke A Cunha et al. Surg Neurol Int. .

Abstract

Background: Infectious endocarditis (IE) clinically manifests as either subacute bacterial endocarditis (SBE) or acute bacterial endocarditis (ABE). Neurologic manifestations are markedly different for these two entities. ABE is caused by invasive, highly virulent pathogens (e.g., Staphylococcus aureus), whereas SBE is attributed to relatively avirulent, non-invasive organisms (e.g., viridans streptococci).

Methods: Here, we reviewed the clinical and radiographic presentations of a patient with cranial complications attributed to ABE. Such patients typically develop central nervous system (CNS) septic emboli resulting in stroke (with/without intracranial hemorrhage (ICH)) and/or mycotic aneurysms resulting in ICH bleeds.

Results: With ABE, cerebrospinal fluid (CSF) seeding may result in acute bacterial meningitis (ABM), documented by positive Gram stain and/or culture for S. aureus, decreased glucose, highly elevated lactose acid levels, or ICH. Alternatively, in SBE, the CSF profile reflects an aseptic (viral) meningitis (i.e., Gram stain and culture negative, a normal glucose, and lymphocytic pleocytosis), while septic microemboli to the vasa vasorum contribute to an inflammatory reaction in the adventitia/muscle layer that weakens the vessel wall and results in mycotic aneurysms that may leak but often do not rupture causing ICH.

Conclusion: Here, we reviewed the literature for intracranial pathology accompanying ABE versus SBE. ABE typically results in acute ischemia, septic emboli, stroke/hemorrhagic infarcts, or ICH. SBE more classically produces septic microemboli and mycotic aneurysms that may leak, but rarely producing ICH. We also presented a patient with ABE attributed to S. aureus whose septic emboli/stroke was accompanied by a mycotic aneurysm; the ruptured resulting in a large right occipital ICH.

Keywords: Acute bacterial meningitis (ABM); SBE; acute bacterial endocarditis (ABE); intracranial hemorrhage (ICH); mycotic aneurysms.

PubMed Disclaimer

Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Head CT showing a large right parieto-occipital hemorrhage with edema secondary to the septic embolus. Note also the presence of marked mass effect as indicated by obliteration of the occipital pole of the right lateral ventricle
See this image and copyright information in PMC

References

    1. Anderson DJ, Golstein LB, Wilkinson WE, Corey GR, Cabell CH, Sanders LL, et al. Stroke location, characterization, severity and outcome in mitral vs aortic valve endocarditis. Neurology. 2003;61:1341–6. - PubMed
    1. Brusch JL. Cambridge, MA: Informa Healthcare; 2007. Infective Endocarditis; pp. 143–181.
    1. Cantier MC, Mazighi M, Klein I, Desilles JP, Wolff M, Timsit JF, et al. Neurologic complications of infective endocarditis: Recent findings. Curr Infect Dis Rep. 2017;19:41. - PubMed
    1. Cunha BA, Gill MV, Lazar JM. Acute infective endocarditis. Diagnostic and therapeutic approach. Infect Dis Clin North Am. 1996;10:811–34. - PubMed
    1. Fernandez Guerrero ML, Gonzalez Lopez JJ, Goyenechea A, Fraile J, de Gorgolas M. Endocarditis caused by Staphyloccocus aureus. xA Reappraisal of the epidemiologic, clinical and pathologic manifestations with analysis of factors determining outcome. Medicine. 2009;88:1–22. - PubMed

Publication types

LinkOut - more resources