Hart R G, Foster J W, Luther M F, Kanter M C
Department of Medicine (Neurology), University of Texas Health Science Center, San Antonio 78284.
Stroke. 1990 May;21(5):695-700. doi: 10.1161/01.str.21.5.695.
We reviewed 212 consecutive episodes of infective endocarditis in 203 patients at six hospitals between 1978 and 1986 and found that 21% were complicated by stroke. Of 133 episodes involving native mitral and/or aortic valves, brain ischemia occurred in 19%, brain hemorrhage in 7%, and non-central nervous system emboli in 11%; vegetations were identified in 56% of 113 adequate echocardiograms and did not correlate with risk of embolism. In native-valve endocarditis, most (74%) ischemic strokes had occurred by the time of presentation and an additional 13% occurred less than or equal to 48 hours after diagnosis; the incidence of brain ischemia was 13% on presentation, 3% during the first 48 hours of hospitalization, and 2%-5% during the remainder of the acute course. Stroke recurred at a rate of 0.5%/day, often heralding relapse/uncontrolled infection. Only 9% of ischemic infarcts were large (all in patients with Staphylococcus aureus infection), while 8% were small and subcortical. Brain hemorrhage occurred primarily at the time of presentation, particularly in intravenous drug abusers, and was associated with uncontrolled S. aureus infection with pyogenic arteritis. Ischemic and hemorrhagic stroke continue to be frequent and important in patients with infective endocarditis and are clustered during uncontrolled infection.(ABSTRACT TRUNCATED AT 250 WORDS)
我们回顾了1978年至1986年间六家医院203例患者连续发生的212次感染性心内膜炎发作，发现21%并发中风。在133次累及天然二尖瓣和/或主动脉瓣的发作中，脑缺血发生率为19%，脑出血为7%，非中枢神经系统栓塞为11%；在113份充分的超声心动图中，56%发现有赘生物，且赘生物与栓塞风险无关。在天然瓣膜心内膜炎中，大多数（74%）缺血性中风在就诊时就已发生，另有13%在诊断后48小时内或48小时发生；就诊时脑缺血发生率为13%，住院的头48小时内为3%，急性病程其余时间为2% - 5%。中风复发率为0.5%/天，常预示复发/感染未控制。仅9%的缺血性梗死灶较大（均见于金黄色葡萄球菌感染患者），而8%为小的皮质下梗死灶。脑出血主要发生在就诊时，尤其是静脉药物滥用者，与金黄色葡萄球菌感染未控制及化脓性动脉炎有关。缺血性和出血性中风在感染性心内膜炎患者中仍然常见且重要，并且集中在感染未控制期间。（摘要截选至250字）
