Marisa Distefano1, Rosalinda Calandrelli2, Vincenzo Arena3, Alessandro Pedicelli4, Giacomo Della Marca5, Fabio Pilato6. 1. UOC Neurologia, Dipartimento di scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Roma, Italy. Electronic address: marisa.distefano@hotmail.it. 2. UOC Radiologia e Neuroradiologia, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Roma, Italy. Electronic address: rosalinda.calandrelli@policlinicogemelli.it. 3. UOC Anatomia Patologica, Dipartimento scienze della salute della donna e del bambino; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Roma, Italy. Electronic address: vincenzo.arena@policlinicogemelli.it. 4. UOC Radiologia e Neuroradiologia, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Roma, Italy. Electronic address: alessandro.pedicelli@policlinicogemelli.it. 5. UOC Neurologia, Dipartimento di scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Roma, Italy. Electronic address: giacomo.dellamarca@policlinicogemelli.it. 6. UOC Neurologia, Dipartimento di scienze dell'invecchiamento, neurologiche, ortopediche e della testa-collo; Fondazione Policlinico Universitario A. Gemelli - IRCCS, Roma, Italy. Electronic address: fabio.pilato@policlinicogemelli.it.
Abstract
BACKGROUND: Stroke is a common neurological complication of infective endocarditis (IE) and it is associated with increased morbidity and mortality but infective endocarditis in acute stroke setting is hard to discover. MATERIAL AND METHODS: A 75-year-old man referred to hospital for the onset of left hemiparesis and dysarthria. His past medical history included hypertension. He had 3 months history of fatigue, fever, and weight loss. Neurological examination revealed left hemiparesis and dysarthria. FINDINGS: Brain CT and CT angiography revealed a right M1 segment occlusion. Thrombolysis was delivered followed by mechanical thrombectomy by clot aspiration and recanalization was achieved. Anatomopathological analysis of the clot showed necrotic material and bacterial colonies consistent with septic emboli. The day after he developed fever and brain CT revealed a right parieto-occipital intraparenchymal and subarachnoid hemorrhage. Blood cultures demonstrated growth of Enterococcus faecalis. Treatment with vancomycin and ampicillin was started. CONCLUSION: Management of acute ischemic stroke related to IE is difficult. The great clinical challenge for the physician is recognizing the signs suggestive of IE in the acute stroke setting. Anatomo-pathological and bacteriological analysis of the clot in patients eligible to mechanical thrombectomy can provide the remarkable advantage to analyse directly the extracted material, allowing an early diagnosis and appropriate antibiotic therapies and treatments.
BACKGROUND:Stroke is a common neurological complication of infective endocarditis (IE) and it is associated with increased morbidity and mortality but infective endocarditis in acute stroke setting is hard to discover. MATERIAL AND METHODS: A 75-year-old man referred to hospital for the onset of left hemiparesis and dysarthria. His past medical history included hypertension. He had 3 months history of fatigue, fever, and weight loss. Neurological examination revealed left hemiparesis and dysarthria. FINDINGS: Brain CT and CT angiography revealed a right M1 segment occlusion. Thrombolysis was delivered followed by mechanical thrombectomy by clot aspiration and recanalization was achieved. Anatomopathological analysis of the clot showed necrotic material and bacterial colonies consistent with septic emboli. The day after he developed fever and brain CT revealed a right parieto-occipital intraparenchymal and subarachnoid hemorrhage. Blood cultures demonstrated growth of Enterococcus faecalis. Treatment with vancomycin and ampicillin was started. CONCLUSION: Management of acute ischemic stroke related to IE is difficult. The great clinical challenge for the physician is recognizing the signs suggestive of IE in the acute stroke setting. Anatomo-pathological and bacteriological analysis of the clot in patients eligible to mechanical thrombectomy can provide the remarkable advantage to analyse directly the extracted material, allowing an early diagnosis and appropriate antibiotic therapies and treatments.