Department of Neurology, Mayo Clinic, Rochester, MN, United States.
Department of Neurology, Mayo Clinic, Rochester, MN, United States.
Handb Clin Neurol. 2021;177:125-134. doi: 10.1016/B978-0-12-819814-8.00008-1.
Infective endocarditis (IE) is an infection primarily affecting the endocardium of heart valves that can embolize systemically and to the brain. Neurologic manifestations include strokes, intracerebral hemorrhages, mycotic aneurysms, meningitis, cerebral abscesses, and infections of the spine. Neurologic involvement is associated with worse mortality, though it does not always portend a poor functional prognosis. Neuroimaging is indicated in patients who have neurologic symptoms, including cerebral vessel imaging in patients who have subarachnoid hemorrhage. In the case of acute ischemic stroke (IS), IV thrombolysis is contraindicated but endovascular thrombectomy may be a consideration. Neurologic findings understandably raise concern about valve surgery when indicated due to the risk of hemorrhage with perioperative anticoagulation. However, most neurologic complications do not preclude valve surgery and valve surgery may in fact be indispensable in some cases to prevent further neurologic problems. Management decisions in patients with IE and neurologic complications should therefore be multidisciplinary with a major contribution from the neurologist.
感染性心内膜炎（IE）是一种主要影响心脏瓣膜内膜的感染，可全身栓塞至大脑。神经系统表现包括中风、脑出血、真菌性动脉瘤、脑膜炎、脑脓肿和脊柱感染。神经系统受累与死亡率升高相关，但并不总是预示着预后不良。有神经系统症状的患者需要进行神经影像学检查，包括蛛网膜下腔出血患者的脑血管成像。对于急性缺血性脑卒中（IS），静脉溶栓禁忌，但血管内血栓切除术可能是一种考虑。由于围手术期抗凝治疗有出血风险，急性缺血性脑卒中患者的神经功能障碍会引起人们对瓣膜手术的关注，这是可以理解的。然而，大多数神经系统并发症并不排除瓣膜手术，在某些情况下，瓣膜手术实际上可能是必不可少的，以防止进一步的神经系统问题。因此，IE 合并神经系统并发症患者的管理决策应由多学科团队做出，神经科医生的贡献尤为重要。
