Almirante B, Tornos M P, Pigrau C, Gavaldá J, Pahissa A, Soler-Soler J
Sección de Enfermedades Infecciosas, Hospital General Universitari Vall d'Hebron, Barcelona.
Med Clin (Barc). 1994 May 7;102(17):652-6.
Neurologic involvement is a frequent cause of morbidity and mortality in patients with endocarditis. The aim of this study was to evaluate the most relevant clinical, epidemiologic and evolutive characteristics of patients presenting neurologic complications during the evolution of endocarditis.
Fifty adult non intravenous drug addict patients who had neurologic complications during endocarditis were prospectively evaluated. The presence of cerebral ischemia, hemorrhage, or infectious complications were studied by established criteria.
Neurologic complications were detected in 50 of the 282 patients (18%) with endocarditis diagnosed over 17 years in one institution. The most common complications were seen in patients with mitral endocarditis of either native valves (28%) or prosthetic valves (30%). The prevalence was identical in the endocarditis of either type of valve (18%). The most frequent complication was cerebral ischemia (29 episodes) and central nervous system infection (8 episodes). Fifty-nine percent of the complications presented prior to the diagnosis of endocarditis with half of the remaining 41% occurring during the first 2 weeks of antibiotic treatment. Endocarditis by Staphylococcus aureus was associated with neurologic complications in 40% of the cases. Global mortality was 48%, being related with prosthetic endocarditis, the existence of cerebral hemorrhage or central nervous system infection, etiology by S. aureus and the presence of anticoagulant treatment.
Neurologic complications are frequent during the evolution of infectious endocarditis, both or an initial feature and during its evolution. The presence of complications considerably impairs the prognosis of this disease.
神经系统受累是心内膜炎患者发病和死亡的常见原因。本研究的目的是评估在心内膜炎病程中出现神经系统并发症的患者最相关的临床、流行病学和演变特征。
对50例成年非静脉吸毒者心内膜炎患者在病程中出现的神经系统并发症进行前瞻性评估。根据既定标准研究脑缺血、出血或感染性并发症的存在情况。
在一家机构17年间诊断的282例心内膜炎患者中，有50例（18%）出现神经系统并发症。最常见的并发症见于天然瓣膜（28%）或人工瓣膜（30%）的二尖瓣心内膜炎患者。两种类型瓣膜的心内膜炎患病率相同（18%）。最常见的并发症是脑缺血（29例）和中枢神经系统感染（8例）。59%的并发症在诊断心内膜炎之前出现，其余41%中有一半在抗生素治疗的前2周内出现。金黄色葡萄球菌引起的心内膜炎40%的病例伴有神经系统并发症。总体死亡率为48%，与人工瓣膜心内膜炎、脑出血或中枢神经系统感染的存在、金黄色葡萄球菌病因以及抗凝治疗的使用有关。
在感染性心内膜炎病程中，神经系统并发症很常见，既是初始特征，也在病程中出现。并发症的存在严重影响该病的预后。
