Cranial magnetic resonance imaging findings in bacterial endocarditis: Theneuroimaging spectrum of septic brain embolization demonstrated in twelve patients

Infective endocarditis (IE) is an elusive systemic disorder that is often a ssociated with neurologic complications. The contribution of brain magnetic resonance imaging (MRI) to the diagnosis of IE and the spectrum of such fi ndings has been only sparsely described previously. The authors report cran ial MRI findings in 12 patients with IE. Each of the patients had MRI evide nce of cerebral embolization, with multiple brain lesions noted in most pat ients (n = 10). Cortical branch infarction was the most common lesion (n = 8), which usually involved the distal middle cerebral artery tree. The next most common finding (n = 7) was numerous small embolic lesions which typic ally lodged in the supratentorial gray-white junction, some of which were c linically silent and many of which enhanced (probable microabscesses). Brai n hemorrhages were noted in our patients, most commonly subarachnoid hemorr hage (n = 3). Two patients developed multiple frank parenchymal macroabsces ses/cerebritis lesions. A previously unreported finding in septic embolizat ion, a stroke that became infected with abscess formation ("septic infarcti on"), was noted in two patients. MRI showed orbital cellulitis in two patie nts. Most patients studied with gadolinium showed enhancement of lesions (n = 5/8). The authors conclude that cranial MRI may be a valuable tool in th e evaluation of patients with IE. The presence of characteristic cranial MR I lesions, especially of multiple types, may prompt early diagnosis and tre atment.