Spectrum of neurological involvement in adult patients with bacterial endocarditis.

OBJECTIVE

To describe the spectrum of neurological involvement, and document in-hospital mortality in adult patients with bacterial endocarditis.

DESIGN

Descriptive, non-interventional.

PLACE AND DURATION OF STUDY

Department of Gastroenterology, The Aga Khan University Hospital, Karachi from November 1999 to October 2002.

PATIENTS AND METHODS

Patients were enrolled from the emergency and outpatient departments, using purposive, non-probability sampling, provided they fulfilled pre-defined inclusion and exclusion criteria. Case records of patients admitted to hospital with a diagnosis of bacterial endocarditis were prospectively analyzed. Data was entered and analyzed on SPSS 11. Frequency, Mean, Mode and Percentage were calculated.

RESULTS

Neurological complications were observed in 14 out of 40 patients (35%). The most frequent complication was embolic infarction (33%), followed by intra-cranial hemorrhage (22 %). Seizures, encephalopathy, abscess and meningitis were all observed in decreasing order of frequency. Out of a total of 14 patients who suffered neurological complications, 06 died (42 %).

CONCLUSION

The nervous system is frequently involved in patients with bacterial endocarditis. The nature of neurological involvement can vary from a fatal embolic infarction to infective complications, such as cerebral abscess or meningitis, to mild encephalopathy. The most frequently noted complication was embolic infarction. In-hospital mortality is significantly high in patients who suffer neurological complications.