Department of Neurology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
Department of Neurology, Beijing Anzhen Hospital Affiliated to Capital Medical University, Beijing, China.
Pediatr Neurol. 2019 Jan;90:56-60. doi: 10.1016/j.pediatrneurol.2018.07.001. Epub 2018 Oct 17.
We explored the relationship between pediatric infective endocarditis and stroke.
All children encountered with infective endocarditis from January 2002 to December 2015 were included as our sample, and their medical records were comprehensively reviewed.
Sixty children with infective endocarditis were identified, including 30 boys and 30 girls aged eight months to 18 years (mean ± SD: 10.3 ± 5.6), and om 43 (71.6%) of these individuals had congenital heart disease. Left-sided endocarditis occurred in 25 patients (41.7%), and vegetations were found in 58 individuals (96.6%). The most often encountered microorganisms were Streptococcus viridans and Staphylococcus aureus, which were identified in five and four patients, respectively. Postendocarditis stroke occurred in nine patients, including five with cerebral infarction, two with intracerebral hemorrhage, and one with subarachnoid hemorrhage. The remaining child experienced cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage simultaneously. The incidence of stroke in children with left-sided endocarditis was significantly higher than that of which in those who had right-sided endocarditis (32% versus 2.8%, P < 0.01). The most common manifestation of stroke was hemiparesis (55.5%). Two girls died of stroke, and the mortality rate in the patients who had stroke was significantly higher than that in those without stroke (22.2 % versus 3.9 %, P < 0.05).
Our data indicate that stroke is common among children with infective endocarditis, especially in those with left-sided endocarditis, and major stroke may increase their risk of death. Congenital heart disease is the main underlying disease in children with infective endocarditis in China.
探讨小儿感染性心内膜炎与脑卒中的关系。
本研究纳入了 2002 年 1 月至 2015 年 12 月期间所有患有感染性心内膜炎的患儿，对其病历资料进行了全面回顾。
共纳入 60 例感染性心内膜炎患儿，男 30 例，女 30 例，年龄 8 个月至 18 岁（均值±标准差：10.3±5.6 岁），其中 43 例（71.6%）患儿存在先天性心脏病。25 例（41.7%）患儿发生左侧心内膜炎，58 例（96.6%）患儿存在赘生物。最常分离到的微生物为草绿色链球菌和金黄色葡萄球菌，分别有 5 例和 4 例患儿分离到这两种微生物。9 例患儿发生感染性心内膜炎后脑卒中，其中 5 例为脑梗死，2 例为脑出血，1 例为蛛网膜下腔出血，1 例患儿同时发生脑梗死、脑出血和蛛网膜下腔出血。左侧心内膜炎患儿脑卒中发生率明显高于右侧心内膜炎患儿（32%比 2.8%，P<0.01）。脑卒中患儿最常见的表现为偏瘫（55.5%）。2 例女孩因脑卒中死亡，发生脑卒中的患儿死亡率明显高于未发生脑卒中的患儿（22.2%比 3.9%，P<0.05）。
本研究数据表明，感染性心内膜炎患儿脑卒中较为常见，尤其是发生左侧心内膜炎的患儿，且严重脑卒中可能增加其死亡风险。先天性心脏病是中国感染性心内膜炎患儿的主要基础疾病。
