Neurological Manifestations of Infective Endocarditis: A Review

Neurological complications are seen in patients with bacterial endocarditis and their incidence has not changed with the advent of antibiotics. Patients with abnormal neurological signs have a grave prognosis. Neurological sequelae of bacterial endocarditis are most often due to septic embolization producing ischemia and/or suppuration, resulting in infarction, hemorrhage, meningoencephalitis, or abscess. Clinical findings vary with the portion of the nervous system affected. The diagnosis should be suspected in the febrile patient with neurological signs of acute onset, the young patient with hemiplegia, the older patient with sudden changes in mentation, or the patient of any age with multifocal neurological signs. Diagnostic measures should include a careful history and physical examination, blood cultures and lumbar puncture where not contraindicated. Treatment is based on therapy of the bacterial endocarditis with bactericidal drugs, and therapy of intracerebral lesions with drugs that penetrate the blood-brain barrier. Consideration should be given to surgical intervention in mycotic aneurysms and brain abscesses.