Catastrophic Multiple Microbleeds Caused by Infective Endocarditis Following Intravenous Thrombolysis and Endovascular Thrombectomy

Ischemic stroke is one of the most common complications of infective endocarditis (IE). IE must be considered as one of the causes of acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO), but early diagnosis of IE is difficult. AIS with ELVO must be treated using endovascular thro...

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Bibliographic Details
Published in:Journal of stroke and cerebrovascular diseases 2019-08, Vol.28 (8), p.e123-e125
Main Authors: Maeoka, Ryosuke, Nakagawa, Ichiro, Ohnishi, Hiroyuki, Takahashi, Kenkichi, Nakase, Hiroyuki, Ohnishi, Hideyuki
Format: Article
Language:English
Subjects:
acute ischemic stroke
catastrophic multiple cerebral microbleeds
endovascular thrombectomy
Infective endocarditis
intravenous thrombolysis
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Summary:Ischemic stroke is one of the most common complications of infective endocarditis (IE). IE must be considered as one of the causes of acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO), but early diagnosis of IE is difficult. AIS with ELVO must be treated using endovascular thrombectomy (EVT), with or without intravenous thrombolysis (IVT). IVT for AIS due to IE is not well established and remains controversial because of the risk of intracranial hemorrhage. A 42-year-old man suffered from right hemiparesis and disorientation, and AIS with ELVO was diagnosed. EVT with IVT was successfully performed and recanalization was achieved, but catastrophic multiple cerebral microbleeds appeared after treatment. EVT without IVT could be chosen for AIS caused by IE to avoid hemorrhagic complications. Hypointense signal spots on T2*-weighted magnetic resonance imaging (MRI) and susceptibility-weighted MRI could facilitate early diagnosis of IE.
ISSN:1052-3057
1532-8511
DOI:10.1016/j.jstrokecerebrovasdis.2019.06.004