Angstwurm K, Borges A C, Halle E, Schielke E, Weber J R
Klinik und Poliklinik für Neurologie, Charité Universitätsmedizin, Berlin, Deutschland.
Nervenarzt. 2004 Aug;75(8):734-41. doi: 10.1007/s00115-004-1685-8.
Infective endocarditis involves the brain in 20-40% of cases. The neurologic syndrome often is the presenting feature. The most frequent neurologic complication is cerebral ischemia. In these patients and those with intracranial hemorrhage, a heart murmur as well as systemic signs of inflammation point to endocarditis. The encephalopathy in endocarditis is mostly due to cerebral infarction. In bacterial meningitis and brain abscess an uncommon isolate arouses suspicion. The most important therapy is antibiotic treatment. Valve replacement improves outcome; in the acute phase of endocarditis, however, it is only necessary in a third of the patients. Neurologic complications interfere with the timing of the valve replacement. If it is urgently required, its risk is reasonable within 3 days after cerebral ischemia; if possible 2-4 weeks should be waited. Cases of successful valve replacement within 4 weeks after intracranial hemorrhage have been reported, but it is recommended to postpone it for 4-6 weeks. There are no data available for the other neurologic complications. Even today patients with endocarditis challenge the diagnostic and therapeutic capacity of various disciplines.
感染性心内膜炎在20%至40%的病例中累及脑部。神经综合征往往是首发特征。最常见的神经并发症是脑缺血。在这些患者以及颅内出血患者中，心脏杂音以及全身炎症体征提示心内膜炎。心内膜炎中的脑病主要是由于脑梗死。在细菌性脑膜炎和脑脓肿中，一种不常见的病原体引起怀疑。最重要的治疗方法是抗生素治疗。瓣膜置换可改善预后；然而，在心内膜炎的急性期，只有三分之一的患者需要进行瓣膜置换。神经并发症会干扰瓣膜置换的时机。如果急需进行瓣膜置换，在脑缺血后3天内进行手术风险是合理的；如果可能的话，应等待2至4周。有报道称颅内出血后4周内成功进行瓣膜置换的病例，但建议推迟4至6周。对于其他神经并发症尚无相关数据。即使在今天，感染性心内膜炎患者仍对各学科的诊断和治疗能力构成挑战。
