Abstract WMP35: The Characteristics of Infectious Intracranial Aneurysm and Indication of Cerebral Angiogram in Infective Endocarditis (IE)

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sung-Min Cho ◽  
Robert Marquardt ◽  
Lucy Zhang ◽  
Prateek Thatikunta ◽  
Ken Uchino ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Intracranial Aneurysm ◽  
Intracerebral Hemorrhage ◽  
Intracranial Hemorrhage ◽  
Cerebral Angiogram ◽  
Tertiary Referral Center ◽  
Valvular Surgery ◽  
Imaging Characteristics ◽  
Perioperative Complication ◽  
Glue Embolization

Introduction: Infectious intracranial aneurysm (IIA) can complicate infective endocarditis (IE). We aim to describe the characteristics of IIA and to assess indications for cerebral angiography. Methods: We reviewed IIAs among 116 consecutive active IE by Duke’s criteria with neurological consultation or admission to stroke neurology service in a single tertiary referral center from January 2015 to July 2016. Susceptibility weighted imaging (SWI) hemorrhage was defined as low signal on SWI in sulci or parenchyma that was not apparent on CT. Results: Of 116 patients, 74 persons (63.8%, mean age of 54) underwent digital subtraction angiography (DSA). IIAs were identified in 13 (17.6%). All of 13 IIAs were unruptured and only one IIA had unrelated intracranial hemorrhage on CT. None of the IIA was seen with CTA or MRA. Eleven (85%) IIAs had clinical strokes (10 ischemic strokes, 1 intracerebral hemorrhage, median NIH stroke scale 3), and 2 neurologically asymptomatic with abnormal MRI. Six of 9 IIAs had SWI hemorrhage in sulci or parenchyma (5 in sulci, 5 in parenchyma, and 1 in both) and all of the lesions were in the vicinity of IIA. Contrast MRI was performed in 7 IIAs, and 4 IIAs had enhancements, all of which were present near the location of IIAs. Ischemic stroke, intracranial hemorrhage, intravenous drug abuse, and type of valve were not associated with the presence of IIA. Of 13 IIAs, 3 remained on antibiotic alone, 5 had antibiotic with coil embolization, and, 5 had antibiotic with glue embolization. Ten patients with IIAs had valvular surgery, including one person with untreated IIA. Out of all patients with IIA, only one intracerebral hemorrhage occurred as perioperative complication unrelated to treated IIA. Conclusions: IIAs were found in approximately one fifth of IE persons who underwent DSA. Imaging characteristics such as SWI hemorrhage in sulci or parenchyma and contrast enhancement appear to correlate with the presence of IIA. DSA should be performed when they are present.

Abstract WMP107: Neuroimaging Characteristics of Intracranial Hemorrhages and Microhemorrhages in Infective Endocarditis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Sung-Min Cho ◽  
Robert Marquardt ◽  
Lucy Zhang ◽  
Prateek Thatikunta ◽  
Ken Uchino ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Intracranial Hemorrhage ◽  
Stroke Risk ◽  
Multivariate Logistic Regression Analysis ◽  
Cerebral Angiogram ◽  
Tertiary Referral Center ◽  
Imaging Characteristics ◽  
Median Volume ◽  
Mycotic Aneurysms ◽  
And Staphylococcus Aureus

Introduction: Intracranial hemorrhage (ICH) is common in infective endocarditis (IE). We explored the imaging characteristics, predictors, and clinical implications of ICHs including intraparenchymal hemorrhage (IPH), and subarachnoid hemorrhage (SAH) and, subdural hematoma (SDH). Methods: We reviewed records of 116 consecutive acute IE patients by Duke’s criteria with neurological consultation or admission to stroke neurology service in a single tertiary referral center from January 2015 to July 2016. ICHs were defined as IPH, SAH, or SDH seen on CT. Microhemorrhages were identified on susceptibility weighted imaging (SWI) on MRI. Patient’s radiographic characteristics and complications were collected. Results: Of 116 patients, 25 persons (21.6%, median age 58) had ICHs, 14 with IPHs, 7 with SAHs, 3 with both IPH and SAH, and 1 SDH. Of 17 (14.7%) IPHs (median NIH Stroke Scale 6 and median volume 38.6cc), 10 (8.6%) IPHs were symptomatic and 7 IPHs were silent. Eleven persons (65%) with IPH also had ischemic strokes. Mycotic aneurysms were identified only in 1 (4.8%) in 21 persons with ICH who underwent cerebral angiogram. MRIs identified 66 persons with microhemorrhages (56.9%, median age 58.5) among 85 who underwent MRI. Eighteen (72%) of 25 persons with ICHs had microhemorrhages in SWI. In multivariate logistic regression analysis, ICH was associated with the presence of >5 microhemorrhages (odds ratio [OR]: 1.25, 95% confidence interval [CI]: 1.04-1.50) and staphylococcus aureus (OR: 1.25, 95% CI: 1.03-1.51). Ten persons (40%) with ICH died (7 with IPH and 4 with SAH) in the same hospitalization. Thirteen persons (52%) with ICH (median 21.4cc in 9 IPHs) underwent valve replacement at median of 13.5 days and 2 persons had new non-fatal strokes (1 IPH and 1 ischemic stroke). Conclusions: Intracranial macro- or micro-hemorrhages are seen in 73 (63%) persons with IE. The mortality of intracranial hemorrhage is high but the perioperative stroke risk appears low.

Magnetic Resonance Imaging Susceptibility-Weighted Imaging Lesion and Contrast Enhancement May Represent Infectious Intracranial Aneurysm in Infective Endocarditis

2017 ◽  
Vol 44 (3-4) ◽  
pp. 210-216 ◽  
Author(s):  
Sung-Min Cho ◽  
Cory Rice ◽  
Robert J. Marquardt ◽  
Lucy Q. Zhang ◽  
Jean Khoury ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Infective Endocarditis ◽  
Magnetic Resonance ◽  
Intracranial Aneurysm ◽  
Contrast Enhancement ◽  
Multivariate Logistic Regression Analysis ◽  
Susceptibility Weighted Imaging ◽  
Resonance Imaging ◽  
Tertiary Referral Center ◽  
Mri Characteristics

Background: Infectious intracranial aneurysm (IIA) can complicate infective endocarditis (IE). We aimed to describe the magnetic resonance imaging (MRI) characteristics of IIA. Methods: We reviewed IIAs among 116 consecutive patients with active IE by conducting a neurological evaluation at a single tertiary referral center from January 2015 to July 2016. MRIs and digital cerebral angiograms (DSA) were reviewed to identify MRI characteristics of IIAs. MRI susceptibility weighted imaging (SWI) was performed to collect data on cerebral microbleeds (CMBs) and sulcal SWI lesions. Results: Out of 116 persons, 74 (63.8%) underwent DSA. IIAs were identified in 13 (17.6% of DSA, 11.2% of entire cohort) and 10 patients with aneurysms underwent MRI with SWI sequence. Nine (90%) out of 10 persons with IIAs had CMB >5 mm or sulcal lesions in SWI (9 in sulci, 6 in parenchyma, and 5 in both). Five out of 8 persons who underwent MRI brain with contrast had enhancement within the SWI lesions. In a multivariate logistic regression analysis, both sulcal SWI lesions (p < 0.001, OR 69, 95% CI 7.8-610) and contrast enhancement (p = 0.007, OR 16.5, 95% CI 2.3-121) were found to be significant predictors of the presence of IIAs. Conclusions: In the individuals with IE who underwent DSA and MRI, we found that neuroimaging characteristics, such as sulcal SWI lesion with or without contrast enhancement, are associated with the presence of IIA

P-OT021. Intracerebral hemorrhage in infective endocarditis, with dramatic response to dexamethasone: A case report

2021 ◽  
Vol 132 (8) ◽  
pp. e127
Author(s):  
Distya Nugrahening Pradhani ◽  
Ismail Setyopranoto ◽  
Indarwati Setyaningsih ◽  
Sri Sutarni
Keyword(s):  
Case Report ◽  
Infective Endocarditis ◽  
Intracerebral Hemorrhage

scholarly journals Intracranial Hemorrhage Following Thrombolytic Use for Stroke Caused by Infective Endocarditis

2009 ◽  
Vol 12 (1) ◽  
pp. 79-82 ◽  
Author(s):  
Parita Bhuva ◽  
Sheng-Han Kuo ◽  
J. Claude Hemphill ◽  
George A. Lopez
Keyword(s):  
Infective Endocarditis ◽  
Intracranial Hemorrhage

Abstract WP418: Characteristic of Intracerebral Hemorrhage Related to Direct Oral Anticoagulant versus Warfarin: Results From the PASTA Registry

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Satoshi Suda ◽  
Yasuyuki Iguchi ◽  
Shigeru Fujimoto ◽  
Yoshiki Yagita ◽  
Takayuki Mizunari ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Oral Anticoagulant ◽  
Hematoma Expansion ◽  
Direct Oral Anticoagulant ◽  
Registry Study ◽  
Stroke Patients ◽  
Hematoma Volume ◽  
Imaging Characteristics ◽  
Warfarin Treatment ◽  
Patient Enrollment

Background and Purpose: The characteristics of direct oral anticoagulant (DOAC)-related intracerebral hemorrhage (ICH) have not been fully clarified. We planned to recruit patients prospectively and to investigate the characteristics and outcomes in patients with ICH receiving direct oral anticoagulant (DOAC) and warfarin treatment. Methods: The prospective analysis of stroke patients taking anticoagulants (PASTA) registry study is an observational, multicenter, prospective registry of stroke patients receiving OAC. Patient enrollment started in April 2016 at 25 tertiary centers across Japan. We compared imaging, clinical characteristics, and discharge modified Rankin Scale (mRS) between DOAC- and warfarin-related ICH patients with atrial fibrillation (AF). Results: A total of 154 patients (51 women; median age 77 [quartiles 69-87] years) were analyzed. Of these, 111 patients (72%) received prior DOAC treatment and the remaining 43 (28%) received prior warfarin treatment (Fig. A, B and C). There were no relevant differences in clinical and hematoma characteristics between DOAC- and warfarin-related ICH regarding baseline hematoma volume (median [quartiles]: DOAC, 11 [5-23] mL vs. warfarin, 12 [5-30] mL; P =0.95), rate of hematoma expansion (DOAC, 12/111 [11%] vs. warfarin, 4/43 [9%]; P =0.80), rate of subcortical hemorrhage (DOAC, 15/111 [11%] vs. warfarin, 10/43 [9%]; P =0.80) and the proportion of patients with unfavorable outcome (mRS, 4-6: DOAC 76/108 [70%] vs. warfarin 23/38 [61%]; P =0.26). Cerebral microbleeds (CMBs) were detected more frequently in DOAC group than in warfarin (47/76 [62%] vs. 11/32 [34%]; P <0.01). Subgroup analyses showed that type of DOAC agent did not result in relevant differences in imaging characteristics or outcome (Fig. D and E). Conclusions: Our results showed that there were no significant differences in hematoma characteristics and functional outcome among AF patients with DOAC- or warfarin-related ICH.

scholarly journals Unusual Intracranial Manifestation of Infective Endocarditis

2021 ◽  
Vol 14 (1) ◽  
pp. 28-32
Author(s):  
Keerthiraj Bele ◽  
Sonali Ullal ◽  
Ajit Mahale ◽  
Sriti Rani
Keyword(s):  
Infective Endocarditis ◽  
Early Diagnosis ◽  
Cerebral Artery ◽  
Mycotic Aneurysm ◽  
Parent Artery ◽  
Left Middle Cerebral Artery ◽  
Risk Of Rupture ◽  
Complete Obliteration ◽  
Glue Embolization ◽  
Left Middle

Objective: The mycotic aneurysm is a rare intracranial pathology seen with pre-existing infective endocarditis. It has a high mortality rate due to its risk of rupture and needs early diagnosis and treatment. Methods: A 23-year male patient who presented with infective endocarditis subsequently developed a left parietal-temporal intracranial haemorrhage with suspicion of aneurysm after the course of antibiotic treatment as seen on Computed Tomography (CT) scan. Digital Subtraction Angiography (DSA) revealed a ruptured fusosaccular aneurysm in the distal parietal branches of the left Middle Cerebral Artery (MCA), for which glue embolization of the distal parent artery and aneurysm was done. Result: The interventional endovascular procedure was done with complete obliteration of the distal parent artery, mycotic aneurysm, and normal filling of the left internal cerebral artery (ICA) branches. Conclusion: Mycotic intracranial aneurysms (MIA) are a rare form of cerebrovascular pathology which needs early diagnosis with endovascular intervention when rupture occurs.

Dental care of patients scheduled for cardiovascular surgery: which protocols to follow?

2021 ◽  
pp. 1-7
Author(s):  
Farhan Raza Khan ◽  
Humayun Kaleem Siddiqui ◽  
Muhammad Tariq Khan
Keyword(s):  
Infective Endocarditis ◽  
Cardiovascular Surgery ◽  
Dental Treatment ◽  
Scientific Evidence ◽  
Real Life ◽  
Cardiac Operation ◽  
Valvular Surgery ◽  
Dental Procedures ◽  
Life Challenges ◽  
Cardiac Operations

Abstract Dental extraction of abscessed or infected teeth before cardiac operation is frequently advocated to lower the risk of infections especially infective endocarditis. The scientific evidence that supports dental procedures before cardio-valvular surgery is however limited. The aim of the present paper was to explore whether there are any protocols for patients needing dental treatment before cardiac operations. Moreover, we have discussed the real life challenges encountered in the management of such patients. Continuous....

Abstract TP358: Prehospital Diagnosis of Intracerebral Hemorrhage in a Mobile Stroke Treatment Unit

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Daniel Vela-Duarte ◽  
Ramnath Santosh Ramanathan ◽  
Atif Zafar ◽  
Ather Taqui ◽  
Stacey Winners ◽  
...  
Keyword(s):  
Intracerebral Hemorrhage ◽  
Hematoma Expansion ◽  
Hospital Treatment ◽  
Treatment Team ◽  
Hematoma Volume ◽  
Treatment Unit ◽  
Stroke Treatment ◽  
Imaging Characteristics ◽  
Mobile Stroke Unit ◽  
The Impact

Introduction: The mobile stroke unit (MSTU) is an on-site pre-hospital treatment team that incorporates laboratory and CT scanner and reduces times to treatment for ischemic stroke thrombolysis. The impact of MSTU on treatment and outcomes of intracerebral hemorrhage (ICH) remains unknown. We report our initial experience with ICH encountered on MSTU. Hypothesis: ICH can be quickly identified using MSTU. Hypertension and coagulopathy are common in ICH evaluated on MSTU. Methods: We identified ICH cases from the prospectively collected database encounters. Demographics, clinical features, MSTU imaging and repeat imaging characteristics were reviewed. Initial and follow-up hematoma volume was calculated by the ABC/2 method. Results: Of 295 encounters on MSTU from July 2014 to July 2015, 20 (6.7%) had intracranial hemorrhage, which comprised of 17 intracerebral, 1 subarachnoid and 2 subdural hemorrhages. Median time to CT diagnosis of ICH from emergency medical dispatch was 31 minutes (interquartile range (IQR) 28-36) and that from last known well was 118 minutes (IQR 39-301). Of the 17 ICH patients, 15 (88%) were hypertensive, with a mean systolic blood pressure of 178.1 and diastolic 91.0 mm Hg. Five (29.4%) individuals were found with INR>1.4, 1 of whom received 4-factor prothrombin complex concentrate. Median NIH Stroke Scale was 11 (IQR 7.5-14.5), and median hematoma volume was 10.7 cc (IQR 4.3-30.8). One patient had significant hematoma expansion as defined by >6 cc or 33% relative volume increase. Conclusions: Over 5% of the cases evaluated in the unit presented with ICH, most of whom were hypertensive and had small hematoma volume. MSTU enables early diagnosis of ICH after activation of emergency system, can provide early treatment, and appropriate triage.

Abstract WP302: Racial Differences in Imaging Characteristics and Risk Factors for Primary Intracerebral Hemorrhage: Final Results from the DECIPHER Study

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Chelsea S Kidwell ◽  
Laura German ◽  
Ravi S Menon ◽  
Nawar Shara ◽  
M. Christopher Gibbons ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intracerebral Hemorrhage ◽  
Racial Differences ◽  
Demographic Data ◽  
Black Communities ◽  
Imaging Data ◽  
Natural History Study ◽  
Imaging Characteristics ◽  
Primary Hemorrhage ◽  
The Impact

Background: Previous studies have reported racial differences in the incidence, location and risk factors for primary intracerebral hemorrhage (ICH). We now report differences in imaging characteristics and risk factors for ICH from the DiffErenCes in the Imaging of Primary Hemorrhage based on Ethnicity or Race (DECIPHER) study. Methods: DECIPHER is a longitudinal, multicenter, MRI-based, natural history study of racial differences in primary ICH. Inclusion criteria were: primary ICH, age ≥ 18, baseline and 1 year MRI scan obtained. Clinical and demographic data were collected on all subjects. Results: A total of 193 subjects of black or white race were enrolled. Subject characteristics overall and by race are provided in the table. Black subjects were younger, had a higher rate of hypertension, cocaine use, and were more frequently smokers. White subjects had a higher rate of hyperlipidemia. A lobar ICH location was more frequent in the white subjects, while infratentorial hemorrhages were more common in blacks. 60% of blacks had 1 or more microbleeds compared to 52% of whites (NS), and blacks tended to have more severe white matter disease. Conclusions: In the DECIPHER study, there were significant racial differences both in the risk factors for primary ICH and in the imaging characteristics. Compared to whites, blacks have a greater rate of hypertension, as well as cocaine and tobacco use. Imaging findings are indicative of a more severe underlying small vessel vasculopathy in the black cohort. The risk factor information may be used to enhance prevention programs tailored for black communities at risk of ICH, while imaging data may provide a useful biomarker to assess the impact of these interventions.

Abstract 162: Microhemorrhages in MRI Predict Infectious Intracranial Aneurysm in Infective Endocarditis

Stroke ◽  
2018 ◽  
Vol 49 (Suppl_1) ◽  
Author(s):  
Sung-Min Cho ◽  
Cory Rice ◽  
Andrew B Buletko ◽  
Robert J Marquardt ◽  
Lucy Q Zhang ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Intracranial Aneurysm
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