Significance of the T2*-weighted gradient echo brain imaging in patients with infective endocarditis
Section snippets
Patients and methods
We retrospectively reviewed consecutive cases of IE treated at the Nagasaki University Hospital from June 2006 to July 2007. All patients were diagnosed as having IE according to the modified Duke criteria. This study included only patients in whom the brain T2*-weighted MR imaging was performed. The initial and follow-up imaging in all patients were undertaken with the 1.5-T scanner (Signa CV/i; GE Healthcare, Milwaukee, WI) with a standard head coil. T2*-weighted MR imaging used a gradient
Results
Clinical characteristics and MRI findings of all patients are shown in Table 1. The most common initial symptoms were fever in four (35.5%), and lumbago in three patients. Others had shoulder pain, general fatigue, emotional change, and hemiparesis. The most common predisposing conditions for IE included mitral or aortic valvular incompetence in eight, and a dental procedure in two, and prosthetic heart valve in one patient. The intervals between the clinical manifestation and the diagnosis of
Patient 1
A 23-year-old woman, who had a history of cardiac surgery for the ventricular septal defect, suffered headache and general fatigue after a dental treatment. She was admitted to a local hospital, and diagnosed as IE. She was transferred to our institute, and underwent the aortic valve replacement. After the procedure, computed tomography (CT) of the brain revealed a parenchymal hematoma in the left frontal lobe (Fig. 1A). Both CT angiography (CTA) and cerebral angiography (CAG) demonstrated an
Discussion
Intracranial IAs are less common (2–4% of endocarditis cases) but they produce potentially devastating neurological complications such as intracerebral or subarachnoid hemorrhage [9], [10], [11]. Since IAs can be clinically silent and some of them could resolve by antibiotic therapy, actual incidence of IAs is considered to be higher than the ones reported in the literatures [12]. IAs may result from septic embolism of vegetations to the arterial vasa vasorum or the intraluminal space, and
Conclusion
The brain T2*-weighted MR imaging in patients with IE may have a potential role to detect minor abnormalities related to IE, with clinical significance of high risk of intracranial hemorrhage. T2*-weighted hypointense signal spots might be specific to brain involvements of IE, and be helpful in diagnosing and monitoring CNS lesions in patients with IE.
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Neurologic complications of infective endocarditis
2021, Handbook of Clinical NeurologyCitation Excerpt :Despite great recent improvement in the quality of noninvasive angiographic images, catheter cerebral angiography remains the modality of choice in these instances. Ischemic stroke is the most common neurologic manifestation of IE, with a reported incidence of 37%–83% (Klein et al., 2009; Morofuji et al., 2010; Hess et al., 2013; Iung et al., 2013; Malhotra et al., 2017). Most strokes are cardioembolic, and risk is influenced primarily by vegetation size, mobility, Staphylococcus aureus infection, and mitral valve involvement (Garcia-Cabrera et al., 2013).
Variable Significance of Brain MRI Findings in Infective Endocarditis and Its Effect on Surgical Decisions
2019, Mayo Clinic ProceedingsCitation Excerpt :Ischemic stroke was the most common finding in 72%, followed by MH in 34%, ICH in 17%, and SAH in 12%. Previous studies have reported rates of IS ranging from 37% to 83% and rates of MH between 57% and 94%.1,15,23-25 The higher rate of MH in other studies may be attributable to the fact that hemosiderin-sensitive MRI sequences were not routinely used in the earlier years of our study time frame.
Utility of Brain Magnetic Resonance Imaging in the Surgical Management of Infective Endocarditis
2017, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :The existing literature assessing the utility of brain MRI in endocarditis consists primarily of descriptive neuroimaging studies of small cohorts. These studies have not assessed the value of brain MRI in guiding clinical decisions and have not examined whether obtaining a preoperative MRI is associated with better postoperative outcomes.5,7-21 In this study, we evaluated the impact of brain MRI findings on the clinical management and functional outcomes in patients with right- or left-sided IE.
Neurological complications of infective endocarditis: New breakthroughs in diagnosis and management
2013, Medecine et Maladies InfectieusesCitation Excerpt :One third of cerebral bleeding in patients presenting with endocarditis is due to the evolution of ischemic infarcts caused by septic emboli, either at the early phase of embolism or later [20]. Cerebral microbleeds have been observed at the acute phase of IE by using MRI, [17,21,22]. These lesions were observed in 57% of the 130 patients included in the IMAGE group prospective study of [17] and could be the most frequent cerebrovascular lesions in patients without neurological symptoms [18].