Neurologic manifestations of infective endocarditis - A 17-year experiencein a teaching hospital in Finland

Background: Many previous studies have endeavored to find appropriate means to reduce the occurrence of neurologic manifestations in patients with inf ective endocarditis (IE). We evaluated patients with IE-associated neurolog ic complications and compared them with patients with IE who did not have n eurologic symptoms. Particular attention was focused on assessing the impac t of cardiac surgery and the presence of potential risk factors for complic ations on the outcome of the patients. Methods: A total of 218 episodes designated as definite or possible IE acco rding to Duke criteria and treated during the years 1980 through 1996 in a Finnish teaching hospital were retrospectively evaluated for neurologic man ifestations. Results: Neurologic complications were identified in 55 episodes (25%), wit h an embolic event as the most frequent manifestation (23/55; 42%). In the majority (76%) of episodes, the neurologic manifestation was evident before antimicrobial treatment was started, being the first sign of IE in 47% of episodes. Only 1 recurrent cerebral embolization was observed. Neurologic c omplications were significantly associated with Staphylococcus aureus infec tion (29% vs 10%; P=.001) and with IE affecting both the aortic and the mit ral valves (56% vs 23%; P<.01), but not with echocardiographic detection of vegetations or anticoagulant therapy. Death during the acute phase of IE o ccurred in 13 episodes (24%) with neurologic complications and in 17 episod es (10%) without neurologic complications (P<.03). In episodes with neurolo gic complications, the IE-associated mortality rate was 25% (10/40) in the medical treatment group and 20% (3/15) in the surgical group. No neurologic deterioration was observed in these surgically treated patients postoperat ively. Conclusions: Our results reinforce the belief that rapid diagnosis and init iation of antimicrobial therapy may still be the most effective means to pr event neurologic complications. These data underscore the importance of dia gnostic alertness to the prognosis of patients with IE.