Article information
En la endocarditis infecciosa aguda se describen complicaciones neurológicas entre 20% y 40% de los casos, lo cual representa un importante factor que predice morbimortalidad, secuelas y discapacidad. Esta entidad se caracteriza por un amplio espectro clínico debido a su compleja fisiopatología, que involucra entre otros, fenómenos inflamatorios, inmunes, infecciosos y embólicos. A pesar de la notable frecuencia de las complicaciones neurológicas en la endocarditis infecciosa, dadas especialmente por enfermedad cerebrovascular y neuroinfecciones, aun existen controversias acerca de algunos aspectos diagnósticos y terapéuticos, en parte por la poca evidencia disponible, las cuales se discuten a continuación, a partir de una serie de casos atendidos en la Fundación Cardiovascular de Colombia.
Palabras clave:
endocarditis infecciosa
enfermedad cerebrovascular
vegetaciones cardiacas
trombólisis
cirugía cardiaca
anticoagulación
Neurological complications of acute infective endocarditis are described in 20%-40% of cases, representing an important predictive factor of morbidity, mortality, sequels and disability. Acute endocarditis is characterized by a wide clinical spectrum due to its complex physiopathology that involves inflammatory, immune, infectious and embolic phenomena. Despite the remarkable frequency of neurological complications in the infective endocarditis especially by cerebrovascular disease and neuroinfections, there are still some controversies about some diagnostic and therapeutic aspects, partly because of the little evidence available. This paper describes a number of cases seen in the Fundación Cardiovascular de Colombia and discusses some aspects related with the diagnosis and treatment of the neurological complications of acute endocarditis.
Keywords:
infective endocarditis
cerebrovascular diseases
cardiac vegetation
thrombolysis
cardiac surgery
anticoagulation
Full text is only aviable in PDF
Bibliografía
[2.]
A.W. Karchmer.
Infective endocarditis.
Braunwald's heart disease, pp. 1077-1105
[3.]
E. Mylonakis, S. Calderwood.
Infective endocarditis in adults.
N Engl J Med, 345 (2001), pp. 1318-1330
[4.]
I. Corral, P. Martín-Dávila, J. Fortún, et al.
Trends in neurological complications of endocarditis.
J Neurol, 254 (2007), pp. 1253-1259
[5.]
G. Habib.
Management of infective endocarditis.
Heart, 92 (2006), pp. 124-130
[6.]
M.C. Kanter, R.G. Hart.
Neurologic complications of infective endocarditis.
Neurology, 41 (1991), pp. 1015-1020
[7.]
M. Heiro, J. Nikoskelainen, E. Engblom, E. Kotilainen, R. Marttila, P. Kotilainen.
Neurologic manifestations of infective endocarditis: a 17-year experience in a teaching hospital in Finland.
Arch Intern Med, 160 (2000), pp. 2781-2787
[8.]
S. Bayer, A. Bolger, K. Taubert, et al.
Diagnosis and management of infective endocarditis and its complications.
Circulation, 98 (1998), pp. 2936-2948
[9.]
D.J. Anderson, L.B. Goldstein, W.E. Wilkinson, et al.
Stroke location, characterization, severity, and outcome in mitral vs. aortic valve endocarditis.
Neurology, 61 (2003), pp. 1341-1346
[10.]
Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group (NINDS).
N Engl J Med, 333 (1995), pp. 1581-1587
[11.]
W. Hacke, G. Donnan, C. Fieschi, et al.
Association of outcome with early stroke treatment: pooled analysis of ATLANTIS, ECASS, and NINDS rt-PA stroke trials.
Lancet, 363 (2004), pp. 768-774
[12.]
A. Salgado.
Central nervous system complications of infective endocarditis.
Stroke, 22 (1991), pp. 1461-1463
[13.]
T.G. Di Salvo, S.B. Tatter, P.T. O Gara, G.P. Nielsen, R.W. De Sanctis.
Fatal intracerebral hemorrhage following thrombolytic therapy of embolic myocardial infarction in unsuspected infective endocarditis.
Clin Cardiol, 17 (1994), pp. 340-344
[14.]
A.J. Hunter, D.E. Giard.
Thrombolytics in infectious endocarditis associated myocardial infarction.
J Emerg Med, 21 (2010), pp. 401-406
[15.]
M. Tan, D. Armstrong, C. Birken, et al.
Bacterial endocarditis in a child presenting with acute arterial ischemic stroke: should thrombolytic therapy be absolutely contraindicated?.
Dev Med Child Neurol, 51 (2009), pp. 151-154
[16.]
M. Siccoli, D. Benninger, B. Schuknecht, R. Jenni, A. Valavanis, C. Bassetti.
Successful intra-arterial thrombolysis in basilar thrombosis secondary to infectious endocarditis.
Cerebrovasc Dis, 16 (2003), pp. 295-297
[17.]
P. Bhuva, S. Kuo, J. Hemphill, G. Lopez.
Intracranial hemorrhage following thrombolytic use for stroke caused by infective endocarditis.
Neurocrit Care, 12 (2010), pp. 79-82
[18.]
M. Junna, C. Lin, R. Espinosa, A. Rabinstein.
Successful intravenous thromobolysis in ischemic Stroke caused by infective endocarditis.
Neurocrit Care, 6 (2007), pp. 117-120
[19.]
S. Sontineni, A. Mooss, V. Andukuri, S. Schima, D. Esterbrooks.
Effectiveness of thrombolytic therapy in acute embolic stroke due to infective endocarditis.
Stroke Res Treat, (2010), pp. 1-5
[20.]
H. Adams, G. Del Zoppo, M. Alberts, et al.
Guideline from the American Heart Association/American Stroke Association Stroke council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologist.
Stroke, 38 (2007), pp. 1655-1711
[21.]
G. Thiene, C. Basso.
Pathology and pathogenesis of infective endocarditis in native heart valves.
Cardiovasc Pathol, 15 (2006), pp. 256-263
[22.]
J.P. Delahaye, P.H. Poncet, V. Malquarti, J. Beaune, J.P. Gare, J.M. Mann.
Cerebrovascular accidents in infective endocarditis: role of anticoagulation.
Eur Heart J, 11 (1990), pp. 1074-1078
[23.]
W. Church.
Aneurysm of the right cerebral artery in a boy of thirteen.
Trans Pathol Soc Lond, 20 (1869), pp. 109
[24.]
S. Kannoth, S.V. Thomas.
Intracranial microbial aneurysm (infectious aneurysm): current options for diagnosis and management.
Neurocrit Care, 11 (2009), pp. 120-129
[25.]
S. Kannoth, R. Iyer, S.V. Thomas, et al.
Intracranial infectious aneurysm: presentation, management and outcome.
J Neurol Sci, 256 (2007), pp. 3-9
[26.]
L. Phuong, M. Link, E. Wijdicks.
Management of intracranial infectious aneurysm: a series of 16 cases.
Neurosurgery, 51 (2002), pp. 1145-1152
[27.]
P. Lerner.
Neurologic complications of infective endocarditis.
Med Clin North Am, 69 (1985), pp. 385-398
[28.]
M. Roach, C. Drake.
Ruptured cerebral aneurysm cause by microorganisms.
N Engl J Med, 273 (1965), pp. 240-244
[29.]
G.L. Bohmfalk, J.L. Story, J.P. Wissinger, W.E. Brown.
Bacterial intracranial aneurysm.
J Neurosurg, 48 (1978), pp. 369-382
[30.]
J.P. Villablanca, R. Jahan, P. Hooshi, et al.
Detection and characterization of very small cerebral aneurysm by using 2D and 3D helical CT angiography.
AJNR Am J Neuroradiol, 23 (2002), pp. 1187-1198
[31.]
R. Agid, S.K. Lee, R.A. Willinsky, R.I. Farb, K.G. Terbrugge.
Acute subarachnoid hemorrhage: using 64 slice multidetector CT angiography to «triage» patients treatment.
Neuroradiology, 48 (2006), pp. 787-794
[32.]
Ahmadi, H. Tung, S.L. Giannotta, S. Destian.
Monitoring of infectious intracranial aneurysm by sequential computed tomographic/magnetic resonance imaging studies.
Neurosurgery, 32 (1993), pp. 45-49
[33.]
Landaw S. Up to date V17.3. Sexton DJ, Hart RG. Anticoagulant and antiplatelet therapy in patients with infective endocarditis [Actualizada en septiembre 2009; acceso 8 agosto 2010]. Disponible en: http://www.uptodate.com/home/clinicians/index.html.
[34.]
W.R. Wilson, J.E. Geraci, G.K. Danielson, et al.
Anticoagulant therapy and central nervous system complications in patients with prosthetic valve endocarditis.
Circulation, 57 (1978), pp. 1004-1007
[35.]
A. Pruitt, R. Rubin, A. Karchmer, G. Duncan.
Neurologic complications of bacterial endocarditis.
Medicine, 57 (1978), pp. 329-343
[36.]
J.L. Carpenter, C.K. McAllister.
Anticoagulation in prosthetic valve endocarditis.
South. Med J, 76 (1983), pp. 1372-1375
[37.]
A. Lieberman, W.K. Hass, R. Pinto, et al.
Intracranial hemorrhage and infarction in anticoagulated patients with prosthetic heart valves.
Stroke, 9 (1978), pp. 18-24
[38.]
P. Tornos, B. Almirante, S. Mirabet, et al.
Infective endocarditis due to Staphylococcus aureus: deleterious effect of anticoagulation therapy.
Arch Intern Med, 159 (1999), pp. 473-475
[39.]
Cerebral Embolism Study Group. Immediate anticoagulation of embolic stroke: a randomized trial. Cerebral Embolism Study Group.
Stroke, 14 (1983), pp. 668-676
[40.]
Cerebral Embolism Study Group.
Immediate anticoagulation of embolic stroke: brain hemorrhage and management options.
Stroke, 15 (1984), pp. 779-789
[41.]
W.R. Scott, P.F. New, K.R. Davis, J.A. Schnur.
Computarized axial tomography of intracerebral and intraventricular hemorrhage.
Radiology, 112 (1974), pp. 73-80
[42.]
G. Habib, J.F. Avierinos, F. Thuny.
Aortic valve endocarditis: is there an optimal surgical timing?.
Curr Opin Cardiol, 22 (2007), pp. 77-83
[43.]
Y. Carrascal, A. Guerrero.
Neurological damage related to cardiac surgery Pathophysiology, diagnostic tools and prevention strategies. Using actual knowledge for planning the future.
Neurologist, 16 (2010), pp. 152-164
[44.]
B. Hoen, F. Alla, C. Selton-Suty, et al.
For the AEPEI group Changing profile of infective endocarditis. Results of a 1 year survey in France.
JAMA, 288 (2002), pp. 75-81
[45.]
C.H. Croft, W. Woodward, A. Elliot, et al.
Analysis of surgical versus medical therapy in active complicated native valve infective endocarditis.
Am J Cardiol, 51 (1983), pp. 1650-1655
[46.]
H.R. Vikram, J. Buenconsejo, R. Hasburn, et al.
Impact of valve surgery on 6 month mortality in adults with complicated, left sided native endocarditis.
J Am Med Assoc., 290 (2003), pp. 3207-3214
[47.]
D. Horstkotte, F. Follath, E. Gutschik, et al.
Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary; the Task Force on infective endocarditis of the European Society of Cardiology.
Eur Heart J, 25 (2004), pp. 267-276
[48.]
L.M. Baddour, W.R. Wilson, A.S. Bayer, et al.
Infective endocarditis. Diagnosis, antimicrobial therapy, and management of complications. A statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association.
Circulation, 111 (2005), pp. 394-433
[49.]
B.A. Carabello, B.W. Lyttle, K. Chatterjee, et al.
ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
J Am Coll Cardiol, 48 (2006), pp. 1-48
[50.]
P. Tornos, B. Lung, G. Permanyer-Miralda, et al.
Infective endocarditis in Europe: lessons from the Euro-Heart Survey.
Heart, 91 (2005), pp. 571-575
Copyright © 2011. Sociedad Colombiana de Cardiología y Cirugía Cardiovascular