Magnetic resonance imaging (MRI) and use of neurochemical brain damage markers show that there is a high incidence of cerebrovascular complications in patients with left-sided infective endocarditis, Swedish researchers report in the July 1st issue of Clinical Infectious Diseases.
However, Dr. Ulrika Snygg-Martin of Sahlgrenska University Hospital, Gothenburg and colleagues also established that the risk of neurological deterioration during cardiac surgery after a cerebrovascular complication is lower than previously thought.
The researchers studied 60 patients who had experienced episodes of left-sided infective endocarditis. Using MRI and testing for the presence of neurofilament protein and glial fibrillary acidic protein in cerebrospinal fluid, the investigators found that 65 per cent had experienced a cerebrovascular complication, about half of which were silent.
Twenty of the patients underwent surgery. The researchers found that no new neurological deterioration was apparent after surgery in patients who had had symptomatic cerebrovascular complications preoperatively.
Some five per cent of patients who had not undergone surgery experienced their first neurological symptom after the start of antibiotic treatment. However, no new symptomatic cerebrovascular complications were detected after ten days of antibiotic treatment.
The team established that greater valvular vegetation was a risk factor for both symptomatic and silent cerebrovascular complications. Staphylococcus aureus etiology conferred a higher risk for symptomatic cerebral complication only.
"It's not surprising that more sensitive detection methods reveal more of the iceberg," Dr. Larry M. Baddour, co-author of an accompanying editorial, commented to Reuters Health.
However, Dr. Baddour, of the Mayo Clinic, Rochester, Minnesota, concluded that "it's good to know that our current standard therapy seems to take care of these problems."
Clin Infect Dis 2008;47:23-30
