Neurological outcome of septic cardioembolic stroke after infective endocarditis

• Published in: Stroke (1970) 2006-08, Vol.37 (8), p.2094-2099
• Main Authors: RUTTMANN, Elfriede, WILLEIT, Johann, ULMER, Hanno, CHEVTCHIK, Orest, HÖFER, Daniel, POEWE, Werner, LAUFER, Günther, MÜLLER, Ludwig C
• Format: Article
• Language: English
• Subjects: Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Brain Ischemia - complications; Cardiac Surgical Procedures - adverse effects; Cerebral Hemorrhage - etiology; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Endocarditis, Bacterial - complications; Endocarditis, Bacterial - surgery; Female; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy; Humans; Incidence; Intensive care medicine; Intracranial Embolism - complications; Intracranial Embolism - epidemiology; Intracranial Embolism - etiology; Longitudinal Studies; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Nervous system (semeiology, syndromes); Nervous System - physiopathology; Neurology; Recovery of Function; Stroke - diagnosis; Stroke - etiology; Stroke - mortality; Stroke - physiopathology; Tomography, X-Ray Computed; Treatment Outcome; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.STR.0000229894.28591.3f

The aim of this study was to evaluate mortality and neurological outcomes of cardioembolic cerebral stroke in infective endocarditis (IE) patients requiring cardiac surgery. A consecutive series of 214 patients undergoing cardiac surgery for IE was followed up for 20 years. In 65 patients (mean age, 52 years), IE was complicated by computed tomography- or magnetic resonance imaging-verified stroke (n=61) or transient ischemic attack (n=4). Perioperative (30-day) and long-term mortality was assessed with regression models adjusting for age. Complete neurological recovery of IE survivors was defined by a modified Rankin score of < or = 1 and a Barthel index of 20 points. Fifty of 61 stroke patients (81.9%) survived surgery. In comparison with nonstroke patients, the age-adjusted perioperative mortality risk was 1.70-fold (95% CI, 0.73 to 3.96, P=0.22) higher and long-term mortality risk was 1.23-fold (95% CI, 0.72 to 2.11, P=0.45) higher in stroke patients. Patients with complicated stroke (meningitis, hemorrhage, or brain abscess) showed a higher perioperative mortality rate (38.9% vs 8.5%, P=0.007) but no higher neurological complication rate than patients with uncomplicated ischemic stroke. Complete neurological recovery was achieved in 35 IE survivors (70%, 95% CI, 55% to 82%). However, in the case of middle cerebral artery stroke, recovery was only 50% and was significantly lower compared with non-middle cerebral artery stroke (P=0.012). Uncomplicated IE-related stroke showed a favorable prognosis with regard to both long-term survival and neurological recovery. The formidable risk of secondary cerebral hemorrhage due to cardiac surgery seems to be much lower than previously thought.