Jiad Estabrak, Gill Sumanjit K, Krutikov Maria, Turner David, Parkinson Michael H, Curtis Carmel, Werring David J
Department of Neurology, National Hospital for Neurology & Neurosurgery, Queen Square, London, UK.
Stroke Research Centre, Department of Brain Repair & Rehabilitation, UCL Institute of Neurology, Queen Square, London, UK.
Pract Neurol. 2017 Jan;17(1):28-34. doi: 10.1136/practneurol-2016-001469. Epub 2017 Jan 3.
Sir William Osler meticulously described the clinical manifestations of infective endocarditis in 1885, concluding that: 'few diseases present greater difficulties in the way of diagnosis … which in many cases are practically insurmountable'. Even with modern investigation techniques, diagnosing infective endocarditis can be hugely challenging, yet is critically important in patients presenting with stroke (both cerebral infarction and intracranial haemorrhage), its commonest neurological complication. In ischaemic stroke, intravenous thrombolysis carries an unacceptably high risk of intracranial haemorrhage, while in intracerebral haemorrhage, mycotic aneurysms require urgent treatment to avoid rebleeding, and in all cases, prompt treatment with antibiotics and valve surgery may be life-saving. Here, we describe typical presentations of ischaemic stroke and intracerebral haemorrhage caused by infective endocarditis. We review the diagnostic challenges, the importance of rapid diagnosis, treatment options and controversies.
1885年，威廉·奥斯勒爵士详细描述了感染性心内膜炎的临床表现，并得出结论：“很少有疾病在诊断方面存在更大的困难……在许多情况下，这些困难实际上是无法克服的”。即使采用现代检测技术，诊断感染性心内膜炎也极具挑战性，但对于出现中风（包括脑梗死和颅内出血）这一最常见神经并发症的患者而言却至关重要。在缺血性中风中，静脉溶栓治疗会带来不可接受的高颅内出血风险，而在脑出血中，真菌性动脉瘤需要紧急治疗以避免再次出血，并且在所有情况下，及时使用抗生素和进行瓣膜手术可能会挽救生命。在此，我们描述由感染性心内膜炎引起的缺血性中风和脑出血的典型表现。我们回顾了诊断挑战、快速诊断的重要性、治疗选择及争议。
