Brain, Vol. 112, No. 5, 1295-1315, 1989
© 1989 Guarantors of Brain
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NEUROLOGICAL MANIFESTATIONS OF INFECTIVE ENDOCARDITIS
REVIEW OF CLINICAL AND THERAPEUTIC CHALLENGES
1Correspondence to: Dr H. R. Jones, Jr. Department of Neurology, Lahey Clinical Medical Center, Burlington, Massachusetts, and Harvard Medical School Boston, Massachusetts 2Department of Neurology, Mayo Clinic and Mayo Medical School Rochester, Minnesota, USA
Correspondence to:
Correspondence to Dr H R Jones, Jr, Department of Neurology, Lahey Clinical Medical Center, 41 Mall Road, Burlington, MA 01805, USA
The nervous system is frequently involved in patients with infective endocarditis. When a careful review of presenting complaints is undertaken, neurological symptoms have been found in as high as 29% of patients. Because these manifestations may be so protean in nature, for example, stroke or transient ischaemic attack (the most common), toxic encephalopathy, meningitis, brain abscess, visual loss, seizures, headache, backache, or acute mononeuropathy, the neurologist needs to consider infective endocarditis as a possible diagnosis in many patients. During the past two decades, infective endocarditis has occurred in an ever widening clinical setting It may often be found in persons unknown to have predisposing cardiac disease. This is particularly true in certain subsets of the population, including the elderly, patients subjected to various invasive procedures leading to nosocomial infection, and drug abusers. New diagnostic studies, including refined bacteriological culture techniques, echocardiography, computed tomography, magnetic resonance imaging, and greater availability of skillful cerebral angiography, make earlier diagnosis of infective endocarditis possible. Despite this, patients with neurological complications continue to have an uncertain prognosis.
Received October 5, 1988. Revised December 13, 1988. Accepted December 20, 1988.
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